Putting People First:
2nd Year Progress
ADASS Spring Seminar
April 2010
Jeff Jerome
National 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 community
but ..……..
• 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
2. SDS and Personal Budgets
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
3. Prevention & cost effective services
29% very, 54% fairly likely to meet target by March
69% 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
4. Information and advice
• 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)
Local Commissioning
44% very, 49% fairly likely to achieve milestone by March
87%: 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
More on PBs ……….
• 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
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.
U - 65's : Proportion receiving community services with a PB
70%
60%
50%
%
40%
30%
20%
10%
0%
Councils
Older People: Proportion receiving community services with a PB
70%
60%
50%
%
40%
30%
20%
10%
0%
Councils
% increases in PBs: Actual v Predicted
250%
%
200%
150%
Actual 10
100%
Predicted
50%
0%
YH NW
GL
E
EM SE
Region
NE
SW WM
PB Numbers : Predicted % PBs March 2011
100%
90%
80%
70%
%
60%
50%
40%
30%
30%
target
20%
10%
0%
Councils
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)
% (of PB) spend on DPs
90
80
70
%
60
50
40
30
20
10
0
EM
NE
SW
GL
SE
Regions
NW
YH
WM
E
%
PBs : Proportions of users & of spend
30
25
20
15
10
5
0
E
NW
EM
GL
SE
NE
WM
YH
Regions
Proportion of Com spend
Proportion with PBs
SW
PB Spend 2009 & 2010 (by Region)
2009
2010
£200,000,000
£180,000,000
£160,000,000
£140,000,000
Spend
£120,000,000
£100,000,000
£80,000,000
£60,000,000
£40,000,000
£20,000,000
£0
North West
London
South East
East of
England
West Midlands Yorkshire and
Humberside
Region
South West
East Midlands
North East
(TOP) 4 Comparisons
Council
A
Council
B
Council
C
Council
D
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 under
£1000
16%
Annual value over
£5000
51%
Annual value
£1000-5000
33%