Finding cashable efficiencies in
Adult Social Care
Rachel Ayling
Towards Excellence in Adult Social Care (TEASC)
Use of Resources in Adult Social Care
What this presentation will cover:
• Financial risks for the sector
• TEASC’s “Use of Resources” Self-Assessment
toolkit
• Sector-led improvement: next steps
“Need for care is rising while public spending is
falling, and there is unmet need. Departments
do not know if we are approaching the limits
of the capacity of the system to continue to
absorb these pressures”.
(National Audit Office 2014)
“Some local authorities are beginning to
believe that they cannot make the level of
savings required without putting their basic
services for vulnerable people at risk”.
(LGA 2014)
“Variations between councils have persisted …
Councils and NHS commissioners have shaped local
health and social care services in very different ways,
and are now transforming these services at different
rates.
Some ASC departments now face much harder
choices than others.”
(TEASC/TLAP 2013)
ASC budget reductions –
the variations between councils
Expenditure on ASC per 100,000 popn (£)
55,000
A
50,000
B
45,000
40,000
C
35,000
D
30,000
2007/08
2008/09
2009/10
2011/12
2010/11
2012/13
Year
London Borough
Shire County
Unitary
Metropolitan Borough
2013/14
Older people supported in residential and nursing care
homes
res/nursing
in100,000
Older people per
popn
ASC activity levels the variations between councils
4000
3500
3000
2500
2000
1500
1000
500
0
E
E
E
E
EM
M
E
EM
L
L
L
L
L
L
L
L
NE
NE
E
N
NE
NW NW
NW NW NW
NW
Region
Region
SE
SE
E
E
S
S
SE
M
M
M
SW SW SW W W W
SW
WM Y
H
YH
H
Y
YH
YH
TEASC “Use of Resources”
Self-Assessment toolkit
• Published in 2013 (jointly with TLAP) and now
being updated.
• Helping councils to assess the scope for further
savings, and to compare themselves with others.
• Includes guidance, published evidence and
case studies.
• Used already by 15+ councils - in different ways and
with different results.
kevin.halden@local.gov.uk
The rationale behind the Self-Assessment
toolkit
• Based on ADASS whole system framework
(2011): “How to make best use of reducing
resources”.
• Focussing on managing demand – using
the available evidence on “what works”.
• Aiming to achieve best value for customers and
the tax payer.
• Six key themes – underpinned by “I” statements.
SIX THEMES OF THE SELF-ASSESSMENT TOOL
1. Prevention: “I am not forced into using health and social care
earlier than I need to. I am enabled to live an active life as a citizen for as
long as possible and I am supported to manage any risks.”
2. Recovery:
“When I initially need health or social care, I am enabled
to achieve as full a recovery as possible and any crises are managed in
a way which maximises my chances of staying at home”.
3. Continued support:
“If I need continued support I will be given a
personal budget and I will be able to choose how to spend this to meet
my needs. I can choose from a range of services which offer value for
money. The resources made available to me are kept under review.”
4. Efficient processes:
“The processes to deliver these three
outcomes are designed to minimise waste, which is anything that does
not add value to what I need.”
5. Partnership:
“The organisations that support me work together to
achieve these outcomes. These organisations include health and social
care, other functions in statutory bodies such as councils or
government, and the independent sector.”
6. Contributions:
“I and others who support me are expected and
enabled to make a fair contribution to this support. These contributions
may be financial according to my means, informal care and support
from those close to me or from volunteers, or from me playing my own
part in achieving these outcomes.”
What the toolkit looks like
• Each of the six areas is sub-divided:
- Evidence-based descriptors of what should save
money .
- More evidence in a supporting “what good looks
like” tool.
- Cross-referenced to ASCE case studies.
- Includes a “worked example”.
• Councils can take stock, and assess their progress
in each area.
SCORE
Min:0
Max: 3
1.
Prevention
1.1
Information and
Advice
(Description of cost-effective
practice)
1.1 Initial Access
(Description of cost-effective
practice)
1.3 Health and wellbeing
(Description of cost-effective
practice)
1.4 Targeted
Prevention
(Description of cost-effective
practice)
Action Plan
BASIS FOR THIS
SCORE
i.e. quick summary
of evidence
NOTES AND
QUERIES
including evidence
gaps
Using the self-assessment toolkit
___________________________________________________
• Designed to be used flexibly – just for reference, or
for a “light-touch” review, or for a more in-depth
assessment.
• Can be used with or without external challenge.
• Can help to make ASC financial issues more
transparent to the wider council.
• Encouraging a rigorous and evidence-based
approach (including benchmarking).
Are our “preventative”
services actually
helping to manage
the demand?
Why is our provision
of home care still
increasing?
We think we’re doing
this well, but is it
saving us any
money?
How do our unit
costs compare
with others?
Where are our
evidence gaps? (What
needs further
investigation?)
Issues (1)
• Rigorous performance management (and data
analysis) are critical to success.
• Many evidence gaps across the whole sector – we
would like to collect more (properly evaluated) case
studies.
• Many dilemmas about how to judge whether we’re
doing the “right” thing – e.g:
• cost vs quality
• “choice” vs economies of scale
• early cash-releasing savings vs investing to save.
Issues (2)
• Many areas of particular uncertainty – e.g.
integration with health. Need for:
NHS to help us manage the demand for social care.
 Datasets that measure investments and benefits for
both health and social care.
 Firmer evidence of which models are cost-effective
for local government.

Identifying and managing financial risks
Examples of “warning signs”:
Low expenditure
on ASC
Low unit costs
(inc fees to the
independent sector)
Low activity
(inc residential
care)
Low
corporate
reserves
and/or
unplanned
overspends
Severe and/or
repeated budget
reductions for ASC
Financial crises
in other services
(e.g. children,
NHS)
What next (for TEASC)?
• Identifying and managing risks for our sector.
NB. Being “at risk” is not the same as
“under-performing”!
• Offering tailored, sensitive support (especially peer
support) where this is most needed.
• The TEASC tool can help with DIY self-assessment.
• External challenge can be commissioned (e.g. via
NEPRO framework).
• We are working with regional SLI networks to see
how they can support this.
• We are building the LGA website as a source of case
examples.
• The LGA intends to offer “peer reviews” that focus on
use of resources. Any volunteers?
Contacts:
Sarah Mitchell, TEASC Programme Director:
Sarah.Mitchell@local.gov.uk
Simon Williams, Co-Chair, ADASS Resources Network:
Simon.Williams@merton.gov.uk
Rachel Ayling, Independent consultant:
rmayling@hotmail.com