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Report to Executive Member for Adult and Community Services Proposals for the Future of Adult Social Care Services

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Report to Executive Member for Adult and Community Services Proposals for the Future of Adult Social Care Services Report to Executive Member for Adult and Community Services Proposals for the Future of Adult Social Care Services 21st July 2010 1. Introduction 10 2. Headline proposals 3. Detail of proposals 4. Appendices a. Summary timeline b. Summary of risks and controls c. Analysis of likely impact Page 1 of 42 20 1. Introduction This report outlines proposals for the future of adult social care provision in Bolton. Why is this being looked at? Adult social care is the single biggest controllable budget in the Council1, and although (as the diagram below shows2) Bolton performs well in comparative spend, the fact remains that without addressing issues of cost in social care the Council will not meet its overall savings targets. This requirement comes at the same time as we are implementing “Putting People First”, the national agenda to transform adult social care. This approach has been retained by the new Coalition government3. It seeks to extend 30 choice and control particularly through the extension of personal budgets – which further undermines the sustainability of our current service models. The final reason for considering a strategic overhaul of the Council’s approach to social care provision is the underlying overspend. This is caused by levels of demand at current cost exceeding annual budgets to the tune of £1.5+ million a year. What is the current situation? Bolton has been externally assessed4 over many years as having some of the best care and support opportunities in England. It also does so at a competitive level of spend5; Fig. 1 Comparison of spend – nearest neighbours BOLTON 1 Schools spend is greater, but it is ringfenced spending and therefore the Council cannot effect reductions to the same extent 2 Data from www.auditcommission.gov.uk 3 A futher White Paper, based on these principles, is planned for 2011 4 http://www.cqc.org.uk/guidanceforprofessionals/adultsocialcare/inspection.cfm 5 Audit Commission Value for Money profiles (pub. April 2010) http://vfm.audit-commission.gov.uk P a g e 2 Page 2 of 42 Fig. 2 Comparison of spend – CIPFA comparable Councils Total spend on ASC (per Council (CIPFA6 Comparator Group) head) Medway Council £354.64 Bolton Metropolitan Borough Council £362.25 Doncaster Metropolitan Borough Council £367.92 City of Wakefield Metropolitan District Council £371.49 Stockton-on-Tees Borough Council £372.25 Wigan Council £381.56 Dudley Metropolitan Borough Council £385.32 Kirklees Metropolitan Council £391.55 Bury Metropolitan Borough Council £423.1 Coventry City Council £423.19 Rochdale Metropolitan Borough Council £424.76 St Helens Metropolitan Borough Council £438.13 Tameside Metropolitan Borough Council £449.21 Oldham Metropolitan Borough Council £457.63 Rotherham Metropolitan Borough Council £467.27 Walsall Metropolitan Borough Council £499.25 40 During 2009-10 the Council’s adult social care services had contact with 31,6887 people, with 9,0388 receiving services from us at any one time. This represents 5% of Bolton’s population. Most aspects of adult social care provision are means tested, so that those with the resources have to pay some or all or their care costs. “Self-funders” may be in 6 Chartered Institute for Public Finance and Accountancy – this is a list of Councils across the country who most closely match the demographics etc. of Bolton 7 RAP R Form 2009/10 8 RAP P1 Form 2009/10 P a g e 3 Page 3 of 42 direct contact with care providers and are not necessarily in touch with social care (although the Council will arrange and provide care for self funders). At present our spend is roughly 50:50 between costs of in house front line care provision, and the amount spent on services “commissioned” from 300+ external organisations. Services are commissioned from small local charities through to national organisations, and including both private and voluntary sector providers. The Council has 50 a legal duty to make sure that care needs are assessed, and to then find an appropriate way to enable those needs to be met – whilst the first function is widely considered to be something that can only be provided by Council employed staff, the second is not. What has been the approach to reducing cost? Having used national data to benchmark current costs it is clear that Bolton Council has a comparatively strong track record in controlling demand through careful care planning and generally competitive rates for commissioned services. The more obvious area where comparative value for money is harder to prove is in the extent to which Bolton Council retains services in house, and the extent to which the unit costs of in house services compare to rates in the independent sector. This report therefore focuses on 60 moving away from being a direct service provider, as well as identifying any opportunistic efficiencies that can be made from better commissioning and improved service design. This report is not a “done deal”, as can be seen from the fact that many proposals are about the Council agreeing in principle to change, rather than pre-determining what exactly this will involve, when and for who. The aim, however, is to make bold proposals to reduce costs whilst maintaining as much service as possible. Because of this it is a first document, designed to be consulted on, and for most of the proposals the intention is to come back to the Executive Member for decisions in the Autumn, after a structured programme of seeking the reactions of people who use services, staff, providers and partners. 70 Some of the cost reduction approaches will work for more than one area of service, but to make it easier for people who are supported by, or work in, a particular area, the report is grouped by services. The service areas looked at are: I. Home Care II. Supported Housing III. Residential Care IV. Preventative services V. Day Services VI. Extra Care VII. Respite 80 As can be expected from a top-performing Council, it is about more than just the money. The report is underpinned by the core values of Adult Social Care in Bolton, ie wanting people to be able to say: P a g e 4 Page 4 of 42 Fig.3 Transforming social care – our vision statements It’s been quick and easy to find my way through the care and support system I’ve been the one deciding what care and 90 support works for me – it’s been my choice I’ve been able to find the right kind of care and support to meet my needs For further information contact: Transformation programme office, Le Mans Crescent, Bolton 01204 337 205 [email protected] 100 P a g e 5 Page 5 of 42 2. Headline proposals These proposals are not a one-off exercise to reduce costs for a year – rather, they reposition social care in Bolton, in terms of both what is provided, and how it is provided. The detailed timetable behind these proposals projects a three year timescale for implementing all of these proposals. The proposals are as follows: a) Home Care 110 1. To complete research work on an enhanced model for reablement, as a development of the current in house Home Support (reablement) service, to report back to the Executive Member by December 2010 2. To commence negotiations on interim 2011/12 rates for commissioned home care with a view to reducing overall levels of spend 3. To commence work to retender existing contracts for commissioned home care provision, with a view to commencing new contracts from June 2011 4. To cease making any new placements to the in house “Home Support (Mental Health) from November 2010 5. To invest grant funding in running at least three programmes in the next twelve 120 months to support local people in becoming trained as “personal assistants” b) Supported Housing 1. To implement a range of measures to improve efficiency and reduce costs of in house services 2. To cease making any new placements to in house services from November 2010 other than in exceptional circumstances 3. To undertake research work to develop and introduce a new alternative model to complement the existing approach, to report back to the Executive Member in Autumn 2010 4. To commence work to outsource the in house service by competitive tendering 130 (to include retendering of existing external provision), subject to meeting our duty to provide best value, with a view to transfer of the undertaking by January 2012 c) Residential Care 1. To commence negotiations on what we pay for commissioned residential care from April 2011 with a view to reducing overall levels of spend d) Day Services 1. To commence a review of Day Services, working with service users and families to identify alternative provision, with a view to closing or replacing existing provision by March 2013. P a g e 6 Page 6 of 42 140 e) Preventative services 1. To cease all current contracts for befriending, advice, drop in, handyperson and lunch club services and replace with a grants scheme, funded at £250,000 lower than current provision (plus any reductions due to government withdrawls of grant) f) Extra Care 1. To commence work to outsource the in house service by competitive tendering 2. To commence negotiations on our 2011/12 rates for commissioned extra care g) Respite 1. To retender currently commissioned older people’s block provision, to 150 complete and start new contracts by December 2011 2. To undertake research work to develop and introduce alternative models, to report back to the Executive Member by April 2011 3. To commence work to outsource the in house service by a method to be determined by April 2011 report back to Executive Member, with a view to transfer of the undertaking in 2012 P a g e 7 Page 7 of 42 3.
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