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Merton Council Adult Social Care
Background and approach to:
New savings for 2015-2016New savings for 2016-2019
Contents1. Context
– Adult Social Care in Merton: what it does and how it compares with other councils
– The financial challenge facing the council and adult social care– The challenge for adult social care nationally– The impact of new legislation
2. Approach being taken– Continued use of Use of Resources framework– Using national evidence– Promoting independence
3. The savings in detail– Savings 2015-2019 (already agreed up to 10/11/14)
– Three replacement savings as part of these (agreed on 10/11/14)
– New savings 2016-2019 (agreed by Cabinet on 8/12/14)
4. Methods for discussion 2
Section 1
Context
What does Adult Social Care do?
Adult social care provides, on a statutory basis:• Preventative services, assessment and care management
• Nursing and residential homes, community services (domiciliary care, day care, meals)
• Re-ablement to prevent hospital admission or enable continued independence, intermediate care (after a spell in hospital)
• Supported and other accommodation
• Individual budgets and direct payments to service users
• Safeguarding
• Provision of equipment and other related areas such as telecare, prescriptions and equipment store
Service users include older people, adults with learning disabilities ormental health issues and with physical or sensory impairments 4
What does financial benchmarking tell us?
• England data shows us:– below average spenders per head of population on older people, – slightly below for other care groups,– above average on our staffing costs for care management– supporting fewer people than average with higher costs per
person, indicating a more targeted service
• The following slides 6-9 give details on this
5
Financial benchmarking(1)
6
The two charts marked unweighted are given here to help members understand the relative size of authorities. As most of our analysis shows unit costs, or other ratios, the size of the authority is usually not apparent.
Source: CIPFA Social Care Benchmarking based on provisional PSSEx1 Report 2013-14 and CIPFA will be sending out final reports following release of the final dataset
Merton spends less per head of population than average.
Merton is a smaller authority than average.
Financial benchmarking (2)How Merton compares on net* spend on specific care groups or settings
7Source: CIPFA Social Care Benchmarking based on provisional PSSEx1 Report 2013-14 and CIPFA will be sending out final reports following release of the final dataset
* net means including the income we get from charges and other sources
Financial benchmarking (3)
8Source: CIPFA Social Care Benchmarking based on provisional PSSEx1 Report 2013-14 and CIPFA will be sending out final reports following release of the final dataset
Merton’s gross spend per head.
Gross means our spend not including the income we get.
Financial benchmarking (4)
9Source: CIPFA Social Care Benchmarking based on provisional PSSEx1 Report 2013-14 and CIPFA will be sending out final reports following release of the final dataset
Merton supports fewer than average people. The costs per person are above average. This reflects a more targeted service.
How do we compare with other councils?
The following graphs show how our services compare to other statistically similar boroughs in 2012-2013
Our comparator boroughs are: Bexley, Brent, Croydon, Ealing, Enfield, Greenwich, Harrow, Hounslow, Kingston, Lewisham, Redbridge, Richmond, Sutton, Waltham Forest and Wandsworth
Data from 2012-2013 (in Local Account for that year):
• Slightly above average users of nursing homes• Use of residential care homes below average• New admissions to all care homes well below average• Home care targeted on fewer and more dependent people• Low costs on day care • Slides 11-14 give more detail
10
11
What services do people use?
12
Average cost of care home placements per person per week
13
Average cost of placements per person per week
14
Average cost of day care per person/week
New admissions to care homes
The financial challenge• The council faces £32m of new savings to find between 2015-2016
and 2018-2019
• ASC needs to find £9.103m of this
• ASC has already saved £16.6m from 2011-2012 to 2014-2015
• ASC has agreed 4.7m of additional savings between 2015-2016 and 2017-2018
• In total between 2011-2012 and 2018-2019 ASC will have saved over £30m
• Details on savings in slides 16-19
• This is against an increase in population of older people of 9% from 2015-2020 (13% for those with dementia) and around 5% for those with learning disabilities (details slides 20-22)
• The national position is similar and is causing concern
• Financial risks are increased due to new legislation 15
Merton Council Medium Term Financial Strategy
Table showing the additional £32m that has to be found by 2018/19 across the whole council, with the contribution
that each department has to make
16
Targets Allocated To Departments To Be Met From Savings And Income
2015/16 £000
2016/17 £000
2017/18 £000
2018/19 £000
Total £000
Corporate Services 99 1,691 2,180 1,446 5,415
Children, Schools & Families 50 1,872 1,839 1,062 4,824
Environment & Regeneration 363 4,329 4,866 2,290 11,848
Community & Housing 220 2,935 4,136 2,590 9,881
Total Income 732 10,827 13,021 7,388 31,968
Cumulative 732 11,559 24,580 31,968
Adult Social Care financial position
Table showing agreed savings 2015-2019 and remaining gap to find
17
Year
Agreed Savings
£000
New Savings
Target £000
Balance of savings to
be found £000
Total Savings
£000
2011/12 4,188 0 0 4,188
2012/13 4,099 0 0 4,099
2013/14 6,162 0 0 6,162
2014/15 2,187 0 0 2,187
2015/16 2,014 220 0 2,234
2016/17 2,328 2,710 0 5,038
2017/18 322 1,576 2,220 4,118
2018/19 0 1,133 1,244 2,377
Total Savings 21,300 5,639 3,464 30,403
Adult Social Care financial position
Adult Social Care Budget 2011-2016, with savings but also adjusted for growth, inflation and technical adjustments
18
YearBudget
£000Savings
£000Growth
£000Inflation
£000
Technical Adjustments
£000
Total Budget
£0002011/12 56,845 (4,188) 1,319 2,456 1,762 58,1942012/13 58,194 (4,099) 1,000 1,120 (1,091) 55,1242013/14 55,124 (6,162) 1,000 742 7,335 58,0392014/15 58,039 (2,187) 1,000 513 (1,867) 55,4982015/16 55,498 (2,234) 1,000 782 1,368 56,414
Total (18,870) 5,319 5,613 7,507
Savings looking ahead
Target savings 2015-2019
19
Year Agreed Savings/Target
£000Cumulative £000
2015/16 2,234
2016/17 5,038 7,272
2017/18 4,118 11,390
2018/19 2,377 13,767
Total Savings 13,767
Adult Social Care financial position
Older People Demographic Growth
20
Data for: Merton ( Tables produced on 14/11/14) from www.poppi.org.uk version 9.0 & www.pansi.org.uk version 8.0_
Population aged 65 and over, projected to 2030
2014 2015Growth
(2014-15) 2020
Growth (2015 to
2020) 2025 2030
People aged 65-69 7,600 7,800 3% 7,600 -3% 8,700 10,400
People aged 70-74 5,500 5,700 4% 7,100 25% 6,900 7,900
People aged 75-79 4,700 4,800 2% 5,000 4% 6,300 6,200
People aged 80-84 3,600 3,500 -3% 3,800 9% 4,100 5,200
People aged 85-89 2,100 2,200 5% 2,400 9% 2,800 3,000
People aged 90 and over 1,300 1,300 0% 1,600 23% 2,000 2,500
Total population 65 and over 24,800 25,300 2% 27,500 9% 30,800 35,200
Adult Social Care financial position
Older People Demographic Growth – DementiaData for: Merton ( Tables produced on 14/11/14) from www.poppi.org.uk version 9.0 & www.pansi.org.uk version 8.0_
21
People aged 65 and over predicted to have dementia, by age and gender, projected to 2030
2014 2015Growth
(2014-15) 2020
Growth (2015 to
2020) 2025 2030
People aged 65-69 predicted to have dementia 94 97 3% 94 -3% 108 129People aged 70-74 predicted to have dementia 150 153 2% 194 27% 187 218People aged 75-79 predicted to have dementia 276 281 2% 294 5% 369 359People aged 80-84 predicted to have dementia 419 419 0% 453 8% 490 620People aged 85-89 predicted to have dementia 422 444 5% 478 8% 556 617People aged 90 and over predicted to have dementia 388 388 0% 505 30% 564 740Total population aged 65 and over predicted to have dementia 1,749 1,782 2% 2,017 13% 2,273 2,682
Adult Social Care financial position
Learning Disability Demographic Growth
Data for: Merton ( Tables produced on 14/11/14) from www.poppi.org.uk version 9.0 & www.pansi.org.uk version 8.0_
22
People aged 18-64 predicted to have a learning disability, by age
2014 2015Growth
(2014-15) 2020
Growth (2015 to
2020) 2025 2030
People aged 18-24 predicted to have a learning disability 414 414 0% 400 -3% 407 459People aged 25-34 predicted to have a learning disability 1,018 1,013 0% 1,008 0% 994 966People aged 35-44 predicted to have a learning disability 852 872 2% 961 10% 996 999People aged 45-54 predicted to have a learning disability 638 649 2% 683 5% 731 799People aged 55-64 predicted to have a learning disability 420 427 2% 501 17% 560 583
Total population aged 18-64 predicted to have a learning disability 3,343 3,375 1% 3,552 5% 3,686 3,806
National picture (LGA ASC Efficiency Programme Report
July 2014)
• Councils in 2014-2015 will spend nearly £14billion on adult social care – 35% of a council’s total budget
• Grant funding to councils cut by 40% during this Parliament period and projected to continue
• Since 2010, overall spend on adult social care has fallen by 12% as councils delivered savings of £3.53 billion to adult social care budgets
• This is at a time when the number of people looking for support needs has increased by 14%
• Councils are also facing huge demographic pressures, significant new legislation on social care – the Care Act 2014 – and fundamental changes to the local government finance system
23
National position: external commentary
Barker Commission 2014
“The reductions in spending and provision, according to the Personal Social Services Research Unit (PSSRU), ‘are almost certainly without precedent in the history of adult social care’ (Fernandez et al 2013a). Social services departments are already struggling to balance the books, with a third of directors of adult services projecting a deficit in this financial year (Appleby et al 2014). Yet there are further cuts in social services spending to come”.
24
National Audit Office 2014
“Pressures on the care system are increasing. Providing adequate adult social care poses a significant public service challenge and there are no easy answers. People are living longer and some have long-term and complex health conditions that require managing through care. 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”.
Impact of new legislation
• Care Act– Overall duty of wellbeing– National eligibility criteria– Safeguarding on statutory basis– Duties towards carers– Oversight of local care market– Funding reform 2016 onwards
• Supreme Court interpretation of Mental Capacity Act– 350 assessments so far this year (40 in 2013-2014)
25
Section 2
Approach being taken
Approach being taken
• Based on Use of Resources framework in use since 2010: this takes a value based approach to investment
• Seeking to drive down costs on long term support and process
• Seeking to retain some investment in prevention and recovery if they work
• Partnership is key but we are not assuming quick savings from it
• Everyone to make the contribution they are able to
• Using a promoting independence approach
27
Investment ModelA whole system approach
offering value to the customer & tax payer
Prevention Recovery Long Term Support
Process Partnership Contributions
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 risks
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
If I still need continued support, I am able to choose how this is done. I can choose from a range of services which offer value for money. The resources made available to me are kept under review
The processes to deliver these three outcomes are designed to minimise waste, which is anything that does not add value to what I need
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
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
28
Investment against this in 2014-2015
29
Prevention
£10.3m
Recovery
£2.3m
Long Term Support
£44.7m
Process
£11.3m
Partnership
-£3.4m
Contributions
-£12.6m
£52.5mEstimated Budget:
Partnership – Allowing for transfers from NHS
Summary of 2010-2014 so far
• Prevention: increased spend is due to concessionary fares. Controllable spend maintained under Ageing Well programme, now assessing outcomes
• Recovery: refocused in mental health and now for older people (re-ablement). Tried retail model for equipment and now reviewing
• Long term support: broadly have absorbed our own demographic and cost pressures, so real term reduction
• Process: made staffing savings in assessment, commissioning and in-house provider services. Extra headline cost is due to NHS staff for Learning Disabilities TUPEing across to council. Now replacing information system
• Partnership: renewed existing formal partnerships in mental health and learning disabilities. Launched integration programme for older people/those with long term conditions. Successful Better Care Fund, some funding for social care
• Contributions: increased income from fees and charges, probably now reached limit 30
National evidence on efficiency
• Two major programmes in last two years
• Local Government Association supported 50 councils to find savings and reviewed what worked. Report published in July 2014
• Association of Directors of Adult Social Services (ADASS) piloted Use of Resources Framework and wrote up learning from this in 2013
• Found very varied scope for savings across councils and variation in how they are tackling it
31
ADASS evidence (from ‘Use of Resources’ pilots)
• Some “traditional” methods used to deliver savings so far (e.g. reviewing costs of packages, freezing or suppressing fees,
increasing discretionary charges)
• But most councils have embraced the need for radical transformation – focusing on managing demand
• All at different stages in journey. (e.g. some councils started to reduce their budgets 5+ years ago; others more recently)
• Success depends on culture change – including the front line and across partner agencies
• Importance of political leadership, especially to address difficult issues such as in-house services or changes in Learning Disability services)
• Scope for further savings varies considerably – but in some places, options are becoming quite limited
32
Approaches to Social Care
Professor John Bolton from LGA review: view that promoting independence likely to yield most from now on
Personalisation
• Strong focus on Personal Budgets/Personal Assistants
• Get the Resource Allocation System right
Efficiency Model
• Assess against eligibility criteria with some Prevention (Re-ablement)
• Procure cost effectively
Integration
• Work with NHS to develop fully integrated services
Promoting Independence
• The purpose of social care is to assist people to live as independent a life as is possible outside the formal care system
33
Promoting independence• People using own assets and being resilient in finding solutions in their
own lives
• Regaining as much independence as possible if they have a crisis/illness
• Family members, with help, supporting their own family members
• Communities and neighbourhoods supporting their vulnerable members
• Council role to intervene when we have to but not in a way which makes people dependent on services. Find simple and practical solutions whenever we can. Look to assets (individual/family/community) before we commit council resources
• This will mean that when people first come our way, we seek to find other solutions rather than council stepping in, e.g. voluntary and faith sector
• If they come out of hospital we will re-able where we need to and support people to regain independence
• Use technology where we can
• Keep ongoing support under review 34
Section 3
The savings in detail
Description
Savings 2015-16
£000
Savings 2016-17
£000
Savings 2017-18
£000Total £000
Access & Assessment - Placements
Below inflation uplift to third party suppliers 350 500 0 850
Brokerage efficiency savings 0 150 107 257
Remodelling and re-procuring the domicilary care service, following the end of the 3 year contract starting in 2012. 250 0 0 250
Domicilary care service 0 0 107 107
Procurement savings 250 250 108 608
Review of care packages with a view to an overall average reduction in line with promoting independence 100 0 0 100
Review of care packages 75 0 0 75
Brokerage efficiency savings 31 242 0 273
Domicilary care service 31 242 0 273
Procurement opportunities (Placement budget) 32 244 0 276
Subtotal (Placements ) 1,119 1,628 322 3,069
36
Details of Savings 2015-2019 (Already agreed up to and including 10
November 2014)
Description
Savings 2015-16
£000
Savings 2016-17
£000
Savings 2017-18
£000
Total £000
Access & Assessment -Non- Placements
Outsource Reablement Service & realise benefits / efficiencies of the remodelled service 100 100 0 200
Reduce Management costs and reduction in staffing costs 0 100 0 100
First Contact Service .Reduce in-house provision of a first contact screening and assessment service, and have this provided within the voluntary sector within the overall costs the sector currently operate within. 125 0 0 125
Subtotal (Access & Assessment - Non Placements) 225 200 0 425
Commissioning
Vol Orgs : Realise benefits of new prevention programme in terms of reduced demand for statutory services, or alternatively if these benefits have not occurred then to reduce investment in the prevention programme through reduced grants to Voluntary Organisations. 0 500 0 500
Supporting People 300 0 0 300
Staffing reductions within the Commissioning Team 71 0 0 71
Subtotal (Commissioning) 371 500 0 871
37
Description
Savings 2015-16
£000
Savings 2016-17
£000
Savings 2017-18
£000Total £000
Direct Provision
Staffing reductions across Direct Provision 99 0 0 99
Day Care Services -Change the day services offer for learning and physically disabled customers who currently use in house day services, mainly High Path and All Saints. 200 0 0 200
Subtotal (Direct Provision) 299 0 0 299
Total Adult Social Care 2,014 2,328 322 4,664
38
Three replacement savings have been put forward for 2015-2016
• Initial access
• Day services for those with learning disabilities
• Reviews
These are for consultation now up to 2 February 2015
39
Initial access• Several access points at present: Merton Adult Access Team (MAAT),
Re-ablement Service (MILES), Hospital Social Workers, Occupational Therapists, Integrated Teams, Voluntary Sector, MASCOT, Council Link
• We will close down one (MAAT) and this work will be dealt with via Link and the Voluntary Sector, as they do already
• Voluntary Sector response from those organisations already used to dealing with initial enquiries, screening for risk, deploying immediate solutions, if possible, signposting elsewhere or referring on if a full assessment needed
• We will continue to review access points to see if there is room to simplify further for customers
• Saving of £125k from staffing reductions
40
Day services for those with learning disabilities
• Savings of £200k from Day Services will be achieved by some staff reductions and further changes to transport provision
• The three day services will remain and customers will be safe and supported affording day time respite for carers. More volunteers will work at centres providing activities, and a closer link with Merton Mencap will result in that group offering activities particularly out of hours
• Our model will be to work with customers and families to increase independence enabling disabled people to play a greater role in the community. This will include agreeing new programmes, where appropriate, with some evening or weekend activities replacing part of their day centre allocation
• For families whose main concern is respite, as noted, the offer will remain with day care being offered in a safe setting with a likelihood of fewer activities on offer to the customer
• Savings beyond 2015-2016 will focus on reviewing the Therapies Service and seeking to make further gains from providing transport in a changed way. There will also be further staff reductions required
41
Review of care packages• Continued but re-focused review of all care and support packages with
an aim of promoting independence and reducing overall levels of service (but accepting that, in some cases, levels will increase and it must be based on the needs of individual customers and carers)
• Often support packages are set up at a time of crisis and left in place long after crisis has passed and the customer should have been supported to be more independent again. We expect to review and re-adjust more frequently
• For those in care home placements, we will also be asking whether they could be living in ordinary local accommodation with support
• Saving of £75k for 2015-2016 but further savings expected in future years
42
New proposals of £5.4m 2016-2019
(Agreed by Cabinet for scrutiny on 8 December 2014)
for discussion now and
continuing onwards
Slides 44-4543
Details of new savings 2016-2019 (Agreed by Cabinet on 8 December 2014
to go forward for scrutiny)
44
DescriptionSavings 2015-16 £000
Savings 2016-17
£000
Savings 2017-18 £000
Savings 2018-19 £000
Total
£000
Access and Assessment - Placements
Placements Income Budgets - Realignment 220 0 0 0 220
Learning Disabilities - High Cost Packages 0 100 0 0 100
Learning Disabilities - Medium Cost Packages 0 400 0 0 400
Learning Disabilities - Direct Payments 0 50 0 0 50
Mental Health - Care Packages 0 76 0 0 76
Older People - Home Care 0 387 0 0 387
Older People - Managing Crisis 0 125 0 0 125
Older People - Direct Payments 0 345 0 0 345
Physical Disabilities - Direct Payments 0 134 0 0 134
Physical Disabilities - Home Care 0 48 0 0 48
Physical Disabilities - High Cost Packages 0 60 0 0 60
Subtotal (Access and Assessment - Placements) 220 1,725 0 0 1,945
Access and Assessment - Non-Placements
Staff savings 0 511 500 483 1,494
Subtotal (Access and Assessment - Placements) 0 511 500 483 1,494
45
Description
Savings
2015-16
£000
Savings
2016-17
£000
Savings
2017-18
£000
Savings
2018-19
£000
Total
£000
Commissioning
Substance Misuse Placements 0 6 0 0 6
CSF Supporting People contracts 0 0 100 0 100
Single homeless contracts (YMCA, Spear, Grenfell) 0 0 56 200 256
Staff savings 0 156 0 0 156
Subtotal (Commissioning) 0 162 156 200 518
Direct Provision
Residential and supported living management - staff reductions
0 0 200 0 200
Staff savings 0 274 0 0 274
Subtotal (Direct Provision) 0 274 200 0 474
Assessment and Commissioning - Placements
Placements budget reductions 0 17 720 0 737
Extra Care Sheltered Housing 0 0 0 450 450
Subtotal (Assessment and Commissioning) 0 17 720 450 1,187
Directorate – Staff Savings 0 21 0 0 21
Total Adult Social Care 220 2,710 1,576 1,133 5,639
Section 4
Process for Discussion
Link to setting the budget
• Cabinet agreed proposals for scrutiny for 2015 and beyond on 10 November 2014 and 8 December 2014
• These are made available for the scrutiny function to look at, and make any recommendations, up to late January
• Cabinet makes its final decisions on 16 February 2015.
It will take into account what scrutiny have to say and also any other significant feedback
• The decision of Cabinet is then subject to the agreement of full Council on 4 March 2015
47
How we plan to discuss this
• Publishing this document on the website for information
• Feedback via email at [email protected]
• Conducting an online survey of your views
• Providing hard copy versions and feedback forms you can post in various locations
• Making accessible versions of these hard copies available as soon as possible
• Public meetings to be held on 15 December 2014 and
13 January 2015
• Meeting with voluntary/user organisations 48
