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Cordis Briefing

October 2017

Follow live @cordisbright

These are extracts from October 2017’s Cordis Briefing. Full versions of the slides are available for subscribers by emailing

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Today’s Briefing

• The State of Social Care

• Sustaining the Homecare Market

BREAK

• Adult Social Care User Survey

• Respite Care and Day Care Costs

• Update on Health and Social Care Integration

Extract


Tipping point or full stretch?

State of Care 2017

Extract


Context

• 9th State of Care report

• Follows the 2016 report which said that social care in particular was at

a ‘tipping point’

• Since then the government of invested an additional £2billion directly

into social care

• Anecdotal reports suggest that this may not be enough to prevent

some councils getting into more serious difficulties

• Fairly health centric in its overview most of the ‘indicators’ apart from

the actual CQC inspection results look at the system of a health

perspective.

Extract


Main points

• CQC are very clear that the future is about an integrated and co-

ordinated approach to delivering person centred care.

• They see health and social care at what they term ‘full stretch’ which

suggests no additional capacity in the system

Extract


Full stretch

• Relentless year on year increase

in attendance at A&E

• Bed occupancy has remained

above the recommended

average of 85% since April 2012

• 2017 saw the highest recorded

occupancy of 91.4% for a whole

quarter

• Detentions under the mental

health act have increased by

20% in the last 2 years –

additional 10,000 people

• Estimate that 1.2 million people

are not receiving the help they

need (up 18% on last year)

• 25% of carers have not received

a single day away from caring in

the five years

• Vacancy rates in social care are

continuing to rise

Extract


Main points

• CQC are very clear that the future is about an integrated and co-

ordinated approach to delivering person centred care.

• They see health and social care at what they term ‘full stretch’ which

suggests no additional capacity in the system

• Some authorities are closer to the tipping point, others are moving in

the opposite direction

• ‘Full stretch’ really means that right now the health ad social care

system is on or around full capacity, even small changes could result is

significant problems.

• There is serious concern about what the winter might bring in terms of

more prolonged cold weather and potentially a surge in vulnerable

people with flu.

Extract


Close to the edge?

Authorities that may be moving closer to the tipping point

Extract


Looking at CQC performance and

spending

• Quartiles are based on LA ratings scores, which have been calculated

by scoring all key question ratings for each Domiciliary Care service

(Community based adult social care services), based on the following

scores:

– 3 for Outstanding

– 2 for Good

– 1 for Requires Improvement

– 0 for Inadequate

• Key question scores are totalled and divided by the maximum possible

score based on the number of key questions rated. CQC quality data

from 1 August 2017

Extract


Residential

Care


Nursing Care


Domiciliary

Care


Combined

results


Spending

power

reduction


Conclusions

• Making ever more stark the differences in experience between areas

of the country which are performing well and those that are not.

• Nothing in the ‘pipe line’ is likely to make this better – Business Rate

retention for example

• No clear policy direction for social care beyond personalisation and

integration

• Lack of central direction makes space for innovation by both providers

and councils

Extract


Cordis Briefing

Dates 2008

24th April

31st July

30th October

Briefing Dates for 2018

• Thursday 18th January 2018

• Thursday 19th April 2018

• Thursday 19th July 2018

• Thursday 18th October 2018

Coffee from 10am for a 10.30am start

Follow @CordisBright for social care news and information

Personal Social Services Adult Social

Care Survey, England 2016-17

The impact of social care services and the profile of service

users

Extract


About the survey

• The survey explores the impact of long-term support services funded

or managed by social services. This includes:

o How effectively these services are helping service users to live safely and

independently in their own homes.

o How the services impact on services users’ quality of life.

• This is the seventh year of the survey but results can only be

compared to the data since the 2014-15 survey responses because

the methodology changed.

• The survey is administered by individual local authorities to a random

sample of eligible service users (aged 18 and over).

• As last year, the overall response rate to the survey was 36% but

response rates vary greatly across questions.

• 79% of respondents had help in completing the survey.

Extract


Profile of service users: self-ratings

35.1

62.9

68.3

77.3

78.4

80

82.7

94.3

35.5

62.3

68.6

76.6

78

79.6

82.6

94.5

35.3

61.8

68.4

77.6

78.4

79.8

80.8

94.6

0 10 20 30 40 50 60 70 80 90 100

Tops up care and support

Rates quality of life as "good" or better

Rates time spent as "adequate" or better

Rates control as "adequate" or better

Rates social contact as "adequate" or better

Receives support from family/friends

Rates general health as "fair" or better

Rates safety as "adequate" or better

2016-17 2015-16 2014-15

Slight declines: hints that the cohort of people actually in

receipt of support is becoming more frail?

Extract


Impact of care and support services

60.3

65.6

66.3

84.5

88.8

91.9

61.3

66.1

67.7

85.4

89.4

92.2

60.9

66.8

68.0

86.4

89.4

92.4

0 10 20 30 40 50 60 70 80 90 100

Self-esteem

Way time spent

Social contact

Safety

Control

Quality of life

2016-17 2015-16 2014-15

Extract


Satisfaction with care and support

services

1.5

2.1

5.8

25.9

64.7

1.6

2.1

6.0

25.9

64.4

1.7

2.1

6.1

25.4

64.7

0 10 20 30 40 50 60 70

Extremely or very dissatisfied

Quite dissatisfied

Neither satisfied or dissatisfied

Quite satisfied

Extremely or very satisfied

2016-17 2015-16 2014-15

Extract


Satisfaction levels by main support

reason 93.4

92.1

89.8

90.3

88.2

87.3

93.1

91.1

90.7

89.6

88.7

88.2

92.9

92.2

91.3

89.2

88.4

88.8

84

85

86

87

88

89

90

91

92

93

94

Learning DisabilitySupport

Support with Memoryand Cognition

Sensory Support Physical Support Social Support Mental Health Support

2014-15 2015-16 2016-17

Extract


Satisfaction levels by age

89.6

89.989.8

89.3

89.9

90.690.7

91.9

88.9

90.4

89.7

89.3

89.7

90.0

90.2

91.3

89.689.8

88.9

89.889.6 89.6

90

91

87.0

87.5

88.0

88.5

89.0

89.5

90.0

90.5

91.0

91.5

92.0

92.5

18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

2014-15 2015-16 2016-17

Extract


Satisfaction levels by care setting

95

91.1

89.3

94.5

90.2

88.9

94.4

91.1

88.6

84

86

88

90

92

94

96

Residential Care Nursing Care Community

2014-15 2015-16 2016-17

Extract


Satisfaction levels by mechanism of

delivery

91.3

90.5

88.8

88.1

90.8

89.6

88.6

87.9

90.2

89.3

88.288.4

86

87

88

89

90

91

92

Direct payment only Part direct payment LA managed personalbudget

LA commissioned supportonly

2014-15 2015-16 2016-17

Extract


Conclusions

• A high proportion of service users report feeling safe; a much smaller

proportion report that they have a good quality of life.

• People are happy with their services; but they are less convinced that

services help their self-esteem or social interactions.

• Learning disability and physical disability clients are becoming less

satisfied.

• Will be interesting to see what happens to these ratings if funding to

these services reduces in the same way as it has for older people’s

services.

• Mental Health clients are becoming more satisfied.

Extract


Conclusions

• Seems to be a clear shift towards dissatisfaction with self-managed or

direct payment budgets.

• And increasing satisfaction with commissioner-managed budgets.

• A slightly surprising finding, but offers more insight into why direct

payments never quite seem to “get going” at scale.

Extract


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