LIVING WITHIN OUR MEANS – ADULT SOCIAL CARE John Bolton Interim Executive Director

1. LIVING WITHIN OUR MEANS – ADULT SOCIAL CAREJohn BoltonInterim Executive Director

2. The financial crisis in Walsall Adult Social Care • We are currently overspending about £4.9 million – and the amount is going up...... • We have to find a further £7 million savings for next year

3. The diagnosis • We have too many people in unfunded posts or things we are doing without proper budget provision • We have allowed the Dom Care market prices to rise excessively this year - £2.5 million • We have savings we have not delivered in both mental health and learning disabilities • We are giving excessive packages of care to some people – long term packages don’t appear to promote independence – the assessment culture

4. The Solution – for us • Get the operational model to work • Ensure people get the right help at point of referral – not rush them into the system • Get the reablement service up to establishment and delivering 75% of people not needing more care • Get reablement to take more risky cases from hospital • Only use intermediate care beds – get therapies and social work to support move on • When older people are ill they will probably get better

5. Continue to find purposeful interventions that promote independence • In mental health services – recovery model – reduce use of respite and crisis beds • In learning disability stronger focus on promoting independence – some new ideas • In Older People with dementia – better evidence base about what works and a more developed care pathway

6. Some rules • No manager has any authority to spend money not in their budget – managers must ensure we still meet our employment responsibilities • Don’t use temporary beds to make an easy solution • We are exploring high cost packages of care • We are exploring more ways to help people be creative – what happened to Personal Budgets and new solutions? • We need a better trained workforce to get this right

7. Wider engagement with partners • With whom should we build stronger links? • Neighbourhoods • Voluntary Sector • Health Services • Housing Services • DISCUSS

8. Remember • We spend about: • £11 million on prevention • £8 million on assessment and care management staff and support • £10 million on in-house services • £55 million on procured/commissioned services • From where should we take money?

9. What are your solutions? • If you are going to be a manager in adult social care for the next 5 + years these are the issues you will face every day of every year! If you don’t want to or cant do it …….. • How do you suggest we reduce our £4 million overspend in this year?

10. AND NEXT YEAR….. • Reduced staffing • Reduced budgets • No apprentices, quality team, • New legislation • Challenge of health integration? • Questions on this?

11. What will/should our operating model deliver? • Reduce demand for residential care (older people) by £1/2 million • Reduce demand for domiciliary care (older people) by £1/2 million through reablement • Reduce domiciliary care through introducing time-monitoring scheme – £½ million • Reduce need for some staff/managers at front end

12. Which other budgets can be reduced? Review of all staffing to take out 20% of current levels (with “preventive services” protected) • Joint Commissioning Unit 3 posts • Mental Health Services 5 posts • Access, Assessment & Care Management 29 posts • Provider Services (including Quality Team) 11 posts • Strategic Development 6 posts £2 million proposed saving Where possible using vacancies and voluntary redundancies to achieve reductions.

13. What can we do differently? • Broadway North – close residential unit • Decommission (parts) of Housing 21 Contract • Review Day Care for Adults with LD • Review Extra Care Housing • Review Low Level Commissioned Services • What don't we have to do? • Recruitability • Apprenticeships • £2.0 million proposed savings

14. What scope for charging? • Impact of social care bill and charging cap What else can we do? • Review base budget • Absorb current costs into new DH grant – spend on exiting services • £1.4 million proposed savings

15. COMMENTS ON SAVINGS

16. PEER REVIEW FINDINGS

17. Peer Review Findings • Impressed with operational model and general level of ownership BUT • Some people don't yet understand it – more to do with longer term teams (incl reviews) • Would like to see more engagement with staff; stakeholders; voluntary sector; community; users and carers in taking forward

18. Peer Review (2) • Need a medium term financial strategy and a business plan to take forward financial challenges • Can we deal with increasing pressures and demands of the new Care Bill? • Can we work closer with Health to find further solutions?

19. Some detailed comments • Financial assessment should not be completed before support plan • Need more Direct Payments to promote social inclusion especially for carers • Need stronger links with Area Partnerships • Examine workloads (and efficiency) of Complex Teams – including waiting lists • Pressures in mental health services

20. Conclusions • New Operating Model the right approach and places the Council in a better position to meet the financial challenges.