wmadass challenge workshop 4 april 2014

West Midlands ADASS- A Regional Summary and PerspectiveChallenge Workshop – 4 April 2014

www.hascc.com wmadass 4 April 2014

2SLI is a Journey – and not always predictable!


3The Purpose of Regional SLI

Share Good Practice (regionally)

Learn from Others (nationally)

Encourage Networking

Provide Support

Celebrate Innovation

For the WM ADASS Branch to provide Leadership and Accountability on SLI


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Our Regional StructureThe Improvement and Efficiency West

Midlands Board, involving Chief Officers and Members, oversees all SLI activity

There is an Adult Social Care SLI Board chaired by a Chief Executive that is responsible for driving and monitoring progress on the SLI programme – this involves the LGA and CQC

The Performance Network, the Head of Adult Social Care/IEWM, and the Peer Challenge Programme Lead report to the WM ADASS Branch which provides the leadership on SLI


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The Components of SLI

Regional Networks: such as Performance and Improvement, which collates, analyses, and promotes Council ASC performance ; CHC; Assistive Technology; Safeguarding; Carers and Dementia Care

Regional Improvement Projects: Winterbourne View; Smarter Commissioning; Dementia Friendly Communities; Improving Personalisation etc

Self-Assessment and Performance Data: against 6 domains related to ASCOF (S/As 12-33 pages in length), and regional performance data has been collated with comparisons for national, regional and family group averages. DASSs have the option of a 1:1 challenge on their self assessment and data

Peer Challenge Programme: 3.5 day peer challenge involving Experts by Experience and Cabinet Members

Offers of Support: Examples include a LA with a high recurring overspend and a follow-on advisory role following a peer challenge

Learning Events: Making It Real; CHC Learning Disabilities; Making It Work – health and social care integration. A dedicated website has been set up: http://hscwm.org.uk/


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Additional WorkAnnual Challenge Workshop – 4 April

2014: DASSs to do a mini-challenge with each other and common strengths and areas for improvement to be identified

Risk Triggers: the Region to consider: looking at what other Regions have done, such as the North West, and to seek to have a small number of risk triggers to provide early warning signs for requesting/providing support


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Other Perspectives on SLI/Peer Challenge (1) – what balance?


8Other Perspectives on SLI/Peer Challenge (2) – where are you?


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How Has it Made Any Difference? (1) It’s shaped our Regional business plan which has 3

key elements: Integration, Prevention/Use of Resources, and Care Bill Implementation

The Region has focussed on some areas of low performance – DToCs and Out of Authority placements/LD, and made improvements

The Regional Peer Challenge programme has been completed in 6 Councils – nearly half of the 14 Councils in the 1st year

The scope for Peer Challenges has included: progress on personalisation; assessment of savings plans; adult safeguarding; commissioning to reduce demand and promote community self-reliance and support; and the effectiveness of prevention/reablement support


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How Has it Made Any Difference? (2) Some general learning points and improvements have

been:

Experts by Experience being a part of the Challenge Team brings a different perspective and challenge, especially on assessing progress on areas like personalisation and co-production

We started with the duration being 2.5 days but after the first Challenge extended this to 3.5/4 days to give greater breadth and depth to the process

Each Team benefits from a 12-14 page summary of the Council's performance/self assessment with a planning meeting in advance – the summary reduces the reading and the meeting helps the team understand their roles, and also allocates tasks/parts of the scope


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How Has it Made Any Difference? (3) The Challenge Team has to be both fair and

robust – two Challenges have resulted in “detailed dialogue” with either the Chief Executive and/or the DASS both during and after the Challenge visit. One has received on-going support from the lead DASS

Another Council, outside the peer challenge programme, has received an external appraisal of its budget position and savings plans

The host DASSs have stated that the Peer Challenge:


12How Has it Made Any

Difference? (4)DASS Comments: gave a wake up call, and major impetus to a review,

on personalisation;

had insufficient evidence for some conclusions;

“since the report (and the feedback) I have spent a lot more time with front line staff and we have developed a clearer strategy for customer engagement in some of our programmes. I have also made a greater priority to engage with wider stakeholders – especially the voluntary sector”;

gave us some new ideas and highlighted key risks for our strategic change programme; and

convinced me of the benefits of a MASH (Multi-Agency Safeguarding Hub)


13Summary and Personal

Perspective on Strengths and Other Observations (1) There have been some major strengths identified

in each Peer Challenge: Carers services and support in Telford & Wrekin The new operating model for reablement and early

intervention in Walsall The vision for IT enabled self assessment which

includes sign posting, triage, safe guarding triggers and user feedback from providers in Worcestershire

Prevention services/support for adult safeguarding, and the Board arrangements in Dudley

The MASH for both children and adults in Stoke (and Staffs)

The POD in Coventry – a very personalised and outcome based recovery programme in mental health services



Perspective on Strengths and Other Observations (2)Observations:o Adult safeguarding has been assessed to be sound

in the two Councils where it was the main scopeo Safeguarding Adult Boards should be more rigorous

in their oversight and monitoring of action plans on Winterbourne View and the Francis Report (especially the latter)

o Progress on personalisation is patchy and performance is comparatively low (against the CIPFA family groupings) for a number of Councils

o There is not a sense of a strong culture of personalisation being embedded in some Councils and the Making it Real priorities are not always completed



Perspective on Strengths and Other Observations (3)o Councils are moving gradually towards co-

production with people who use services, but it is not always evident

o Black and Minority Ethnic Communities are rarely referred to in self-assessments and there is limited attention to, or presentation of, their needs and responses by host Councils during visits

o Often, early intervention and prevention, including reablement, are put forward as the main transformation initiative, but there has been a lack of a detailed, robust business case behind some such plans – and the scale/pace is often moderate



Perspective on Strengths and Other Observations (4)o There is limited evidence of any links between early

intervention and prevention, and to Corporate leadership, as opposed to Adult Social Care, on Councils helping communities to help themselves ie. community asset building

o Budget and Resource plans are extremely demanding in all Councils. Some may be unrealistic without a fundamental review, particularly by those Councils in which existing savings have not been achieved and which are over-spending

o Further integration plans with the NHS are in their initial stages and no Council that has had a peer challenge has chosen to go down a route of wholesale integration – this is an observation, not a criticism



Perspective on Strengths and Other Observations (5) More on the Money: To state the obvious, the

Use of Resources is a challenge for all Councils. Specific comments -

What we know of the national position (ADASS):o Local Government is faced with funding reductions

of 33% over 4 years – approximately 8% a year. 2015-17 cuts will be at the same rate

o In contrast, total public spending is being reduced by 8% over 4 years

o The net spending on adult social care is £13bno Equals: 34% of total local govt spending (£39bn)o Total annual savings from ASC are £2.68bn by

March 2014 – 20% of net spending



Perspective on Strengths and Other Observations (6) Plus:o The IFS said the Chancellor’s extension of

austerity to 2018/19 means that by the end of this financial year, 60% of planned spending cuts will be yet to come

o ASC remains a large part of local government costs and will need to contribute to savings, whilst demand grows via demographic changes

o Impact: 35% of Councils have reduced the number of older people using services by more than 40% between 2005/6 and 2012/13 (ageuk)

o 896,000 65+ received services in 2012/13 compared to 1,231,000 in 2005/6 (ageuk)



Perspective on Strengths and Other Observations (7) NAO - ASC in England Overview Report March 2013:o ASC spending fell 8% (£1.4bn) in real terms between

2010/11 and 2012/13 – 75% via reduced volumes of care and 25% by reducing costs

o Between 2007/8 and 2012/13, new referrals remained constant around 2m, assessments dropped from 660,050 to 603,250, and new users declined from 476,830 to 403,995 (minus 15%)

o The number of adults receiving state-funded care fell from 1.8m in 2008/9 to 1.3m in 2012/13 – a drop of nearly 30%

o The Audit Commission noted that ASC savings constituted 14% of LA savings in 10/11 to 11/12, but totalled 52% in 12/13 to 13/14

o It is difficult to assess the impact of preventative services



Perspective on Strengths and Other Observations (8) The Health Foundation and Nuffield Trust Report

March 2014:o Services in the community for older adults have seen

the biggest reductions, with £539 million taken out of home and day care alone – a 23 per cent reduction in expenditure (from 9/10 to 12/13)

o It is highly likely that reduced spending on social care for older adults is having a negative effect on the health and wellbeing of users and carers, but poor linkage between health and social care data at a national level means that it is currently difficult to quantify the impact

o “….without adequate data to assess this impact, the NHS and government are flying blind when it comes to managing demand and planning for the future” Holly Holder, joint author (Guardian 26 March 2014)



Perspective on Strengths and Other Observations (9)Barker Commission Interim Report 3 April

2014:o “Improved productivity, improvements in

end-of-life care, better integration, ensuring NHS money is spent on what is cost-effective are explored (option 1), but considered insufficient to meet all the costs”

o Proposals are considered for the ‘harder’ long-term choices, including extending NHS charges, developing a health insurance market, and introducing a hypothecated tax for health and social care. Responses to these are requested.



Perspective on Strengths and Other Observations (10)Regional: Analysis of 3 Councils from

Budget Plans for 2014/15 and beyond – for ASC each Council plans to save around £20-25m over the next 4-5 years

Another Council is planning to save 15% of its ASC budget in one year - 2015/16

In at least 3/6 peer challenges, existing savings were behind schedule and/or demand pressures were causing an overspend



Perspective on Strengths and Other Observations (11)The Commissioning Response:o Exhaust efficiencies and cuts in non-

essential services and “back-office” functions

o Transformation, to bring about the salvation of adult social care via the holy trinity of:PersonalisationIntegration, with Health (via the Care Bill

and the Better Care Fund)Early Intervention and Prevention support,

including communities supporting themselves



Perspective on Strengths and Other Observations (12) Questions?:o Does the commissioning response on personalisation,

integration, and reablement/prevention have sufficient scale and pace?

o Is Market development sufficiently sophisticated/comprehensive? - Andrew Kerslake: “Moving from the procurement of care to market facilitation is hard for most commissioners”

o Can you continue to fund and expand prevention/reablement/early intervention if the evidence base is poor, and if demand pressures/budget savings persist?

o How realistic are plans for 2015/16, especially if existing savings are not being delivered?

o Is the Region learning enough from each other about the response to the challenges on the use of resources?



Perspective on Strengths and Other Observations (13)Summary:o If SLI, Transformation, and Savings Plans are based

on the Holy Trinity of personalisation, integration, and prevention – will they be able to deliver both better outcomes and the required savings?

o Or is it mythology rather than evidence based change?

o Together, they are meant to solve the financial challenge – what some might see as heroic actions which, according to Andrea Sutcliffe (when at SCIE) lead to a mistaken assumption, for example, “that integration is the new fresh-faced comic book hero fearlessly felling new foes” (Guardian). Are you ready to find your own, new, heroic initiatives?!


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Conclusions There has been good progress over the last year with all

the foundations stones in place for an effective Regional approach to SLI

There are some clear signs of learning, mutual support, and constructive and robust challenge from SLI, with more work to do on “so what?” from our arrangements

There is further work to do on areas such as risk triggers and using the Challenge Workshop to inform the Region’s future Business Plan and approach to SLI, including peer challenge

There are some areas to consider for the commissioning response to the current challenges

The Financial Challenge remains significant and may benefit from a more coordinated regional, learning approach


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Recommendations - Process: Self-assessment template - any changes?

Submission date of the new self-assessment to be agreed – end of June 2014?

Final Letters after a Peer Challenge should be published on the WMADASS website and Council websites

The Region should develop Risk Triggers and Early Warning signs for SLI - via the Performance Network?

Plus:o Updated performance data for 13/14 to be preparedo Information Leaflet for participants to be written on the

purpose/process of peer challenge (full guidance already drafted)o Evaluation/Feedback Template, post the Peer Challenge, to be

developedo Anything else from the TEASC summary docs (circulated by David

Anwyl-Hughes by email on 26 March)

wmadass challenge workshop 4 april 2014

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