CIFA North West Financial Challenges Facing Adult Services

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CIFA North West Financial Challenges Facing
Adult Services

• April 2007
• Paul Stevenson, Asst Director Finance IT,
  Department of Adult Services,
• Wigan MBC

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INTRODUCTION

• Overview of the main financial challenges facing
  Adult Social Care and possible solutions
• Focus on Adult Social Care not additional
  departmental functions which may have been merged
• Personal perspective!

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CONTEXT

• Complexity of operational financial
  inter-relationships
• Social and health care jargon!
• Restricted settlements Adult Social Care does
  not get the sympathy of say healthcare or
  education
• Impact of CSSR 2007 increased funding above
  inflation for Education already promised in
  Budget 2007 where does this leave Adult Social
  Care?
• NHS dimension complexity
• Other partners NHS / Voluntary Sector /
  Children Services / Supporting People etc..
  complex mix!
• Demographic changes highlighted by Wanless
  review

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ADSS SURVEY 2006

• Key Points-
• Overspend nationally 1.77m
• Pressures on LD Services in particular
• Eligibility Criteria tightened substantial /
  critical now represents circa 70 of authorities

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FINANCIAL CHALLENGES

• Impact of budget split from Children Services
• NHS dimension
• Individualised budgets / direct payments
• Gershon
• Care Home Fees
• Fees and Charges
• Equal Pay
• Performance v Finance agenda
• LD / PD Pressure group lobby
• Supporting People

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FINANCIAL CHALLENGES

• Disaggregation of Adults and Childrens Services-
• Transition pressures
• Pressures previously accommodated through budget
  shifts shifting between Adults and Childrens
  not possible post disaggregation
• New departmental functions combined with Adult
  Social Care impact variable

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FINANCIAL CHALLENGES

• NHS Dimension-
• NHS Financial deficits
• Some cost shunting, e.g. termination of services
  at short notice
• Continuing Care differing treatment, postcode
  lottery
• NHS counter argument impact of tightening
  eligibility criteria?
• Pooled budgets some NHS trusts withdrawing from
  arrangements

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FINANCIAL CHALLENGES

• Individualised Budgets-
• Emerging challenge
• 13 pilot sites in progress varying rates of
  progress
• Oldham very much progressed, other more limited
  progress to date
• Issues?

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FINANCIAL CHALLENGES

• Issues for Consideration-
• What funding streams to include?
• Basis of calculation of budgets needs to be
  soundly based, otherwise risky
• Resource Allocation model?
• Impact on commissioning intentions block
  contracts could be more risky?
• Impact on achievement of Gershon savings?

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FINANCIAL CHALLENGES

• Direct Payments-
• Still very much with us though may ultimately
  be subsumed by Individualised Budgets
• Direct payments theoretically cost neutral though
  important notes of caution
• Can resources be transferred from where they were
  previously incorporated into services?
• New services are we tapping into previously
  unmet need?

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FINANCIAL CHALLENGES

• Gershon-
• The first 3 years 2.5 savings per annum
  cashable / non-cashable
• Highest level of savings from Adult Services
• High expectations on Adult Services for Gershon
  Mark II
• Target 3 savings all cashable
• Soft targets already taken much less scope
  now available
• Will they be achievable?

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FINANCIAL CHALLENGES

• Care Home Fees-
• Pressure on authorities to increase fees arising
  from-
• Impact of successive increases in minimum wage
• Increased regulation costs
• Impact of higher energy and insurance costs
• Important partner
• Increasing risk of legal challenges against fee
  levels

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FINANCIAL CHALLENGES

• Fees and Charges-
• Increasing pressure on fees and charges to assist
  balanced budget, eg, Cheshire increase
• Do not impact equally on all service users
• Higher charges resulting in increasing attempts
  to avoid paying
• Extent to which charges can continue to be
  increased is becoming limited

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FINANCIAL CHALLENGES

• Equal Pay-
• Significant cost particularly for Adult Social
  Care e.g. in-house home care staff
• A lot of authorities have reached settlements
• No win no fee layers circling does not mean the
  issue has gone away
• Impact on future pay

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FINANCIAL CHALLENGES

• Performance v Finance Agenda-
• Not always going in same direction
• Some conflict between performance targets and
  finances
• E.g. pressures on helped to live at home some
  home based packages more costly than residential

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FINANCIAL CHALLENGES

• Pressure Group Lobbies-
• Dont underestimate the impact of groups
  particularly LD and PD services?
• Increasingly vocal and literate
• Choice agenda and Valuing People raising
  expectations unreasonably?

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FINANCIAL CHALLENGES

• Supporting People
• SP Inspection regime increasingly looking at
  alignment of funding to strategic priorities
• Risk of funding switches impacting on LD services
• Eligibility of services funded still an issue

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POSSIBLE SOLUTIONS?

• Home Care Internal v External split
• Re-ablement service
• Transition
• Commissioning Contracting
• Human Resources initiatives
• Transport costs
• Eligibility
• Fees and Charges
• CSED / CSIP initiatives

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POSSIBLE SOLUTIONS workstream approach

• Home Care Internal v External-
• Cost of in-house generally higher
• Is your mix appropriate?
• Delivery of savings depends on impact of TUPE

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POSSIBLE SOLUTIONS

• Home Care Re-ablement Service-
• Re-ablement ablement enablement service
• Immediate intervention at vulnerable time for 6
  weeks period, then withdraw or reduce service
• Heavily promoted by CSED
• Jury still out unproven savings?

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POSSIBLE SOLUTIONS

• Transition-
• Effective well resourced transition team needs to
  be in place
• Maintain (rebuild?) good relationship with
  Children Services
• Be involved at an early stage Children Services
  and relatives perspective

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POSSIBLE SOLUTIONS

• Commissioning and Contracting-
• Clear commissioning strategy needed which sets
  our where you want to go to get to over next 5
  years
• Needs to be suitably quantified in terms of
  projected numbers and costs
• Effective use of contracting to get best value
  from services procured consider alternative
  bases of contracting, framework agreements,
  e-auctions etc..

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POSSIBLE SOLUTIONS

• Human Resources-
• Control sickness levels e.g. nurse on call
  service
• Terms and conditions are they appropriate in
  all areas e.g. sleep in payments
• Skill mix of workforce options for transferring
  admin type tasks from social work staff?

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POSSIBLE SOLUTIONS

• Other In-house Services-
• How do they compare in cost terms of private
  sector alternatives?
• Is there a case for maintaining in-house?

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OTHER AREAS?

• Transport Costs-
• Are you paying for transport costs as you should
  be?
• Is there a case for restricting transport costs
  where higher rate mobility allowance paid?
• Is there a client contribution?
• Consider joint contract arrangements eg
  Children Services / Adult Services

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OTHER AREAS

• Eligibility-
• Is your eligibility criteria appropriate to the
  level of budget resources?
• Though beware of risks associated with move to
  Critical only

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OTHER AREAS

• Fees and Charges-
• Any scope for increased charges?
• Do you differentiate between differing costs of
  Day Service provision in reflecting in charges?
• Are charging provisions re direct payments
  service users in sync?

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CSED / CSIP INITIATIVES

• 9 useful initiatives including-
• Re-ablement service
• Disabled badges
• Vocational v administrative tasks
• Financial Assessments
• Mobile working
• Etc..
• Select initiatives to pursue carefully avoid
  overload!

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CSED / CSIP INITIATIVES

• NW Centre of Excellence-
• High cost LD / PD placement project
• Useful information produced look at this from
  your authoritys perspective any outliers?
• Looking at options for collaborative procurement
  out of this next stage

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GENERAL ISSUES

• Corporate Relationships-
• Good corporate relationships essential
• Communicate the issues at all levels more
  sympathetic response if members and senior
  officers are engaged

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GENERAL ISSUES

• Information Systems-
• Do systems allow for finance activity to be
  aligned to operational activity?
• Effective corporate financial system and social
  care client record system essential to achieve
  this

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CONCLUSIONS

• Big financial challenges over next 3 years
• Efficiency measures will need to be delivered not
  only to achieve balanced budgets but to meet
  stiff Gershon targets
• Dont profess to have all answers what are your
  solutions?

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QUESTIONS / COMMENTS?