1. Andrew Webster 11 March 2016 Funding settleme nt Social Care Issues

2. 1 Headlines Core funding falls by 6.1 % or £2.6bn in 2016/2017 Council tax referendum at 1.99% Social care precept of 2% - £400m against need of £700m But …

3. 2 Settlement December 2015 – loss of RSG % LA Type16-1717-1818-1919-20 County councils-33.7-39.7-41.9-70 London-24.61-26.4-23.76-31.96 Mets-24-25.2-22.8-29.8 Unitaries-28.7-31.8-30.4-44 England-27.6-30.7-28.7-40.1

4. 3 Revenue Support Grant £ per head population LA Type2015/162016/172017/182018/192019/20% change CCN (inc. DC allocation) 136.5 89.74 53.05 29.85 6.85 -94.94 Mets216.76164.8123.295.4266.82-69.17 London213.94161.05118.7190.561.59-73.45 England181.98131.791.2968.139.01-78.56

5. 4 Additional Funding Per Head of 65+ Yr Old Population Available from Total BCF/Social Care Precept Funding LA Types 2017/18% Diff CC Allocation 2018/19% Diff CC Allocation 2019/20% Above CC Allocation County councils £79.58-116.62-254.11- Met£110.6939%276.86137%428.0468% London137.1772%315.09170%466.5184% UA95.3220%211.8882%324.4728% England93.6718%210.1880%322.5627%

6. 5 Winners and losers? Councils that have diverse income sources Councils with strong private social care markets Councils that have commercial partnerships Combined authorities with Mayors that can secure devolution deals Councils that can create asset backed vehicles to invest in transformation including housing redevelopment Councils that don’t have social care responsibilities Councils with high performing and financially robust health care partners  Councils that rely on RSG for a high proportion of their income  Councils with lower tax bases from Business rates and less ability to charge fees  Councils that have high levels of publicly funded care and whose providers are reliant on Council contracts for viability  Councils whose health partners cannot sustain commitments to protect social care services  Councils with limited scope to increase housing stock

7. 6 Tackling the Issues

8. 7 Why have most integration initiatives failed and a few succeeded? Most pilots, pioneers and vanguards founder when they challenge whole system Mainstream culture Alliances are broken by restructuring, re-organisations and political change Leadership turnover Regulations and targets drive leaders to focus on short term delivery and survival Short term priorities Changing the whole system requires new questions as well as new answers Reframe issues Successful integrators have been around decades not years, building trust and insight Consistent local leaders Successful integrators deal with immediate issues and keep their eye on the longer term prize. Invest for improvement Lots of barriers Only a few overcome them

9. 8 Learning from ambitious localities All the major players, including providers, are represented on the Board The Chief Executives work together in an executive team that supports the Board and runs the system like an organisation All the money is in the pool – the system budget is the only budget GPs are represented by a federation that can speak with one voice They adapt the national rules to fit local priorities and establish the right incentives – e.g. do not use fines, do not attach conditions to transfers What marks out the localities that are pooling £100m+ ?

10. 9 Driving efficiency to release resource Increasing delays, poorer outcomes, rising costs, lower satisfaction, poorer returns and less resilience Inadequate information and advice Poor risk assessment in urgent care and response Mandatory reporters knowledge and skills Poor community health and care interventions Inability to work with complex individuals and their carers Inadequate early intervention and prevention responses Limited outcomes focus Inadequate understanding of factors leading to service demand Drift into poor health and well beings Inadequate secondary tier coverage – access to other services Poor understanding of risk and risk mitigation strategies No available service response to meet immediate need Focus on processing the case not the intervention Limited intervention capacity Case drift Key worker turnover Performance measures poorly targeted No suitable intervention available to respond to complexity Inability to get other systems to work together Incentives focussed on the short term Poor skills and knowledge base to deliver effective responses Systems skewed to the tertiary end of the system No available service Responses to intervene earlier Evidence base evolving System focused on the here and now No incentives for delivering sustainable outcomes Poor data systems to identify re- reports

11. 10 Redesigning services to deliver better outcomes Wider community taking care of themselves Specialised services and integrated commissioning at scale across a large geography Integrated self managed locality teams incentivised to keep people at home Simple digital access Population segment and service need Scale and channel of service delivery

12. 11 Andrew Webster Director Public Sector and Healthcare andrew.webster@kpmg.co.uk Thank you