1. Finding cashable efficiencies in Adult Social Care Rachel Ayling Towards Excellence in Adult Social Care (TEASC)

2. What this presentation will cover: Financial risks for the sector TEASC’s “Use of Resources” Self-Assessment toolkit Sector-led improvement: next steps Use of Resources in Adult Social Care

3. “Some local authorities are beginning to believe that they cannot make the level of savings required without putting their basic services for vulnerable people at risk”. (LGA 2014) “Need for care is rising while public spending is falling, and there is unmet need. Departments do not know if we are approaching the limits of the capacity of the system to continue to absorb these pressures”. (National Audit Office 2014)

4. “Variations between councils have persisted … Councils and NHS commissioners have shaped local health and social care services in very different ways, and are now transforming these services at different rates. Some ASC departments now face much harder choices than others.” (TEASC/TLAP 2013)

5. B C A D ASC budget reductions – the variations between councils

6. ASC activity levels - the variations between councils E EM L NE NW SE SW WM YH Older people in res/nursing homes Region

7. TEASC “Use of Resources” Self-Assessment toolkit Published in 2013 (jointly with TLAP) and now being updated. Helping councils to assess the scope for further savings, and to compare themselves with others. Includes guidance, published evidence and case studies. Used already by 15+ councils - in different ways and with different results. kevin.halden@local.gov.uk

8. The rationale behind the Self-Assessment toolkit Based on ADASS whole system framework (2011): “How to make best use of reducing resources”. Focussing on managing demand – using the available evidence on “what works”. Aiming to achieve best value for customers and the tax payer. Six key themes – underpinned by “I” statements.

9. SIX THEMES OF THE SELF-ASSESSMENT TOOL 1. Prevention: “I am not forced into using health and social care earlier than I need to. I am enabled to live an active life as a citizen for as long as possible and I am supported to manage any risks.” 2.Recovery: “When I initially need health or social care, I am enabled to achieve as full a recovery as possible and any crises are managed in a way which maximises my chances of staying at home”. 3.Continued support: “If I need continued support I will be given a personal budget and I will be able to choose how to spend this to meet my needs. I can choose from a range of services which offer value for money. The resources made available to me are kept under review.”

10. 4. Efficient processes: “The processes to deliver these three outcomes are designed to minimise waste, which is anything that does not add value to what I need.” 5. Partnership: “The organisations that support me work together to achieve these outcomes. These organisations include health and social care, other functions in statutory bodies such as councils or government, and the independent sector.” 6. Contributions: “I and others who support me are expected and enabled to make a fair contribution to this support. These contributions may be financial according to my means, informal care and support from those close to me or from volunteers, or from me playing my own part in achieving these outcomes.”

11. What the toolkit looks like Each of the six areas is sub-divided: - Evidence-based descriptors of what should save money. - More evidence in a supporting “what good looks like” tool. - Cross-referenced to ASCE case studies. - Includes a “worked example”. Councils can take stock, and assess their progress in each area.

12. SCORE Min:0 Max: 3 BASIS FOR THIS SCORE i.e. quick summary of evidence NOTES AND QUERIES including evidence gaps 1. Prevention 1.1 Information and Advice (Description of cost-effective practice) 1.1 Initial Access (Description of cost-effective practice) 1.3 Health and wellbeing (Description of cost-effective practice) 1.4 Targeted Prevention (Description of cost-effective practice) Action Plan

14. Using the self-assessment toolkit ___________________________________________________ Designed to be used flexibly – just for reference, or for a “light-touch” review, or for a more in-depth assessment. Can be used with or without external challenge. Can help to make ASC financial issues more transparent to the wider council. Encouraging a rigorous and evidence-based approach (including benchmarking).

15. We think we’re doing this well, but is it saving us any money? Are our “preventative” services actually helping to manage the demand? How do our unit costs compare with others? Why is our provision of home care still increasing? Where are our evidence gaps? (What needs further investigation?)

16. Rigorous performance management (and data analysis) are critical to success. Many evidence gaps across the whole sector – we would like to collect more (properly evaluated) case studies. Many dilemmas about how to judge whether we’re doing the “right” thing – e.g: cost vs quality “choice” vs economies of scale early cash-releasing savings vs investing to save. Issues (1)

17. Many areas of particular uncertainty – e.g. integration with health. Need for:  NHS to help us manage the demand for social care.  Datasets that measure investments and benefits for both health and social care.  Firmer evidence of which models are cost-effective for local government. Issues (2)

18. Low expenditure on ASC Low unit costs (inc fees to the independent sector) Low activity (inc residential care) Low corporate reserves and/or unplanned overspends Financial crises in other services (e.g. children, NHS) Severe and/or repeated budget reductions for ASC Identifying and managing financial risks Examples of “warning signs”:

19. What next (for TEASC)? Identifying and managing risks for our sector. NB. Being “at risk” is not the same as “under-performing”! Offering tailored, sensitive support (especially peer support) where this is most needed.

20. The TEASC tool can help with DIY self-assessment. External challenge can be commissioned (e.g. via NEPRO framework). We are working with regional SLI networks to see how they can support this. We are building the LGA website as a source of case examples. The LGA intends to offer “peer reviews” that focus on use of resources. Any volunteers?

21. Sarah Mitchell, TEASC Programme Director: Sarah.Mitchell@local.gov.uk Simon Williams, Co-Chair, ADASS Resources Network: Simon.Williams@merton.gov.uk Rachel Ayling, Independent consultant: rmayling@hotmail.com Contacts: