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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Care Duration
THE CARE BUS
THE CARE BUS

9. 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

10. The Challenge – Culture
THE CARE BUS
Dependency
Social care teams

11. 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

12. 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