Putting People First: 2nd Year Progress

ADASS Spring Seminar April 2010

Jeff JeromeNational Director

Social Care Transformation

Overview Drawn from…

Milestones Self-Assessment (Oct - Dec 09) : Soft data from 150 councils

• PPF Facts and Figures Survey 2010 :Hard data from 149 councils

• My observations

Headlines (end of 2nd year)

• Confident re milestones ( ???)• PPF principles have significant purchase, and

‘story’ better understood• Progress nationally is steady and less uneven,

but still worrying group of stragglers re PBs• PB 30% target is challenging re NI130, but achievable re eligible users

Headlines - Personal Budgets

At end March 2010:• 140,000 PBs - half go to OP (30,000 more if one-offs included)

- predicted 205,000

• 1 in 6 of eligible users; half of these get £100+pw• £900+m expenditure, £670m via DPs (£680m 2009)• 8 in 10 councils give majority of PB spend via DPs• 40 commit 20%+ of community budget in PBs

Headlines - Personal Budgets• Predicted to rise to 376,000 by March 2011

– 41% of people supported in communitybut ..……..

• Last year’s predictions optimistic: - predicted 120% increase, delivered 50-80% (205,000) (140 – 170,000)

And….

• NI130 30% target would require 500,000 PBs(376,000 is only 22% of NI130)

SELF-ASSESSMENT

Milestone 1: Effective partnerships (users, carers, citizens)

77% say very, 20% fairly likely to meet March target

Support requested:• Assistance with developing ULOs• Sharing good practice examples• Improving communication and awareness

National Delivery Plan:• Practice guidance showing how councils are effectively co-producing PPF -

June 2010• Practice guidance with focus on co-production of PBs and SDS - Sept 2010• Comms Strategy ?.........

Observation• Milestone not well articulated re ULOs• ‘Story’ still developing

63% very, 33% fairly likely to meet 2011 PB target(PB Survey: Only 12 councils predict to have less than 30%; but only 41% of councils

have mainstreamed PBs

Support requested:• Regional collaboration and learning networks• Sharing best practice• Helping with streamlining processes

National Delivery Plan:• Specialist PB support to councils - Ongoing• Finance / IT Systems Principles and Requirements April 2010• Review of NI 130• Common RAS learning sets• Finance and I.T work

Observations• Most have SDS incorporated in core operating model; numbers will increase faster• Too much time spent on RAS, and too much process• ‘Managed services’ guidance well received

2. SDS and Personal Budgets

29% very, 54% fairly likely to meet target by March69% have a strategy/and or investment programme for prevention and early

intervention

Support requested:• Regional groups and best practice examples• Help with evidence and benchmarking• Equalising priorities between health and social care

National Delivery Plan• ‘Building Community Capacity’ - practice examples and framework for

development of local strategies to be published • CSED working on several efficiency initiatives

Observations• Re/enablement core, but size variable; often not well joined with NHS • Community dev/outreach approaches (not often alongside reablement)• Telecare sporadic

3. Prevention & cost effective services

• 67% very, 27% fairly likely to achieve milestone• Only 53% have a strategy for universal access to information,

support and guidance

Support requested:• Best practice and regional groups• Guidance on how to measure success

National Delivery Plan• Work ongoing re ‘national spine’• Further work agreed to identify self-funder position; exploring financial advice• National Care Service expectations (pending)

Observations• Community immersion v Call centres; ‘badging’• Interactive aproaches/I.T.• Enthusiasm from Council leads (needs structural support)

4. Information and advice

Local Commissioning44% very, 49% fairly likely to achieve milestone by March87%: good SC transformation/NHS commissioning link; 98% working well with

local providers

Support Requested:• Regional groups & practice examples of providers having successfully changed• Clarification of relevant legal and procurement regulations.• Clearer guidance on ‘good commissioning’ strategies, practice examples

National Delivery Plan• Working together for change: provider development programme• National Market Development Forum• Commissioning Work: Andrew Webster

Observations• TCS; IC/reablement; joint investement• Procurement/contracting/dialogue with suppliers • Costs/contributions policy/subsidy/incentives• Understanding community need; JSNA; market position statement• Balance of local investment

• Personal budget numbers are forecast to rise to 236,500 by September 2010

• … then to over 376,000 by March 2011• This equates to approximately 27% and 41% of

people respectively receiving ongoing community based services

More on PBs ……….

Numbers: Proportions of users with PBs

• … of OP with services: - 31 LAs have 5% or less - 74 have 10 - 20% (17 had 10%+ last year)

- 24 with 20% plus, highest 72%

• …of ‘other adults’ with services - 19 LAs have 10% or less - 67 LAs 20% or more, highest 59% (21 last year)

• 26 LAs gave info on care home residents who have been allocated PBs:– 18 have allocated less than 100 PBs – 7 between 100 - 500 – 1 over 500.

Community Service Users : Proportion with a PB March 2010 (by Council)

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Older People: Proportion receiving community services with a PB

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PB Numbers : Predicted % PBs March 2011

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PB Spend • As proportion of total social care gross budget: - 88 LAs commit 5% or less via PBs - 15 LAs 10% or more, the highest at 37%

• As proportion of community services gross budget: - 48 LAs commit 10% or less via PBs - 42 LAs commit 20% or more, highest 79% (20 last year)

• Of money allocated in PBs: 74% are DPs; 26% are ‘managed’ accounts

- 17% of the ‘managed budgets’ are via third parties

• 52% of all PB recipients had £5k or above p yr (just less than half last yr)

Community budget : proportion allocated to PBs 2010

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PBs : Proportions of users & of spend

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Proportion of Com spend Proportion with PBs

PB Spend 2009 & 2010 (by Region)

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end

2009 2010

(TOP) 4 Comparisons

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Council

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Proportion of eligible users with PBs 57% 57% 49% 47%

Proportion of Social Care Budget 37% 11% 16% 25%

Proportion of Community Services Budget 79% 61% 56% 50%

DPs as proportion of PB spend 13% 17% 51% 36%

Issues Arising

• N1 130• PB improvement work; RAS; I.T.• Market Shaping/development• Budget management/balance of investment• Wider thinking (whole community, transformation)• Workforce design; culture• CQC, performance assessment• Keeping PPF at forefront in the financial climate

Reminder of some key goals……

• Getting the money to individuals• Ensuring everyone helped to identify need and

potential solutions• Ensuring better choice, control, experience through broadening market offer (inc Q.A)• Helping people be as active and independent as poss• Making best overall use of resource (inc workforce)• Helping people to stay safe

END

Annual value of PBs

Annual value over £500051%

Annual value £1000-5000

33%

Annual value under £100016%