Background

Social care provides support, care and safeguards for those people in our communities who have the highest level of need and for their carers. However, there is not enough funding for social care and it has been reducing in real terms. 

In March 2015, ADASS published a discussion paper ‘Distinctive, Valued, Personal. Why Social Care Matters: The Next Five Years’. The discussion paper outlines the developmental steps needed to be taken in order to ensure a safe, secure and personalised care and health system for older and disabled people. 


Scope

ADASS has set up an Integration Task and Finish Group, initially for a year, in response to it being identified as a business plan priority for the organisation. The purpose of this is to co-ordinate the Association’s effort and maximise the its impact in relation to improving outcomes for people needing care and support as well as health care.

 

Terms of reference

ADASS’s Integration Task and Finish Group will focus on five objectives:

  • supporting the President and Vice President in their work with Government, other sector leadership bodies
  • developing the ADASS policy position and narrative on integration and devolution
  • collating, disseminating and supporting examples of new and good practice from councils
  • supporting and developing the ADASS voice and policy line on integration and devolution
  • ensuring that the voices of people who use services and wider communities are heard 

In so doing, the Task Group will be particularly mindful of:

  • The extent to which integration improves well-being and health outcomes for people and cost savings/ increases for health and social care.
  • The ability to shift the paradigm from cure / long term care to prevention and personal and community resilience
  • The ability of NHS and social care providers to see the person as a person rather than focusing on individual conditions.
  • The readiness of local NHS and social care services to shift the focus of prevention, care and support from institutions to the home or community setting
  • The extent to which people are able to have control of their lives, their health and their care, including through self-assessment, support planning and personalised services The regulatory implications of integration and devolution
  • The affordability implications of new policy initiatives and models of care and the impact on the overall funding settlement for adult social care
 

Evidence gathering

ADASS has met with a number of organisations and those with a particular interest in integration, to help with evidence gathering, identify issues and look at emerging themes. This has included representatives from the LGA, NHS Providers and NHS Confederation.

 

Issues identified 

Five Year Forward View and Distinctive, Valued, Personal

Recent care and health reforms, the NHS Five Year Forward View and ADASS’ DVP further recognise the need for care and health systems to be locally led, with a stronger emphasis on prevention and more personalised services. However, the pace of change suggested in the 5YFV will be very difficult to achieve. 

The Integration Task and Finish Group has found that within the 5YFV there are not many actions on prevention. This is particularly concerning because there is a Department of Health proposal to remove £200 million from councils’ public health grants. The ADASS response focused on the proposal being a short-term fix.

 

Devolution

Devolution is one of the Government’s flagship policies. The Government has introduced the Cities and Local Government Devolution Bill.  A number of bids have been submitted for devolution of government services. The bids are currently being assessed as part of the spending review which will be announced on 25th November. 

There are a number of issues for ADASS in relation to integration. In no particular order, these are:

  • There is a risk that timescales or behaviours mean that systems change does not involve the individuals and communities it intends to serve.
  • There is a risk that integration becomes an end in itself rather than a means to an end.
  • There is a risk that the social model is subjugated to the medical model, that social care becomes ancillary health care and that social work reverts to case management.
 

Better Care Fund

The Better Care Fund (BCF) was announced by the Government in the June 2013 spending round, to ensure a transformation in integrated health and social care. The Government has announced that BCF will continue beyond April 2016. However, this message isn’t getting fed down to local areas. NHS England is looking to clarify the situation with local areas. Early clarification of aims, processes and timelines will help local partners to plan beyond 2016.  

ADASS has consistently argued that there is a need for a separate transformation fund which would support the service transformation needed to make the integration of social care and health a reality, with part of the funding supporting investment in a more ambitious prevention strategy, with an estimated net rate of return of 90 per cent.

At the last BCF Stakeholder Group meeting it was suggested that ADASS under take a stock-take on in year position on 15/16 BCF in terms of CCGs potentially reneging on transfers and/or identifying the position for 16/17.

The BCF and 5YFV have triggered a range of new initiatives:

 

New Models of Care

All new models of care sites are rethinking and redesigning the way care is delivered. The sites will show what the future NHS could look like: what integration can really mean in practice, for different communities, patient groups and staff; and across home and community based services, urgent and emergency care, elective care and specialised services.

 

Vanguards

Through the New Models of Care Programme, individual organisations and partnerships were invited to apply to be Vanguard sites. These organisations worked with national partners to co-design and establish new care models, tackling national challenges in the process. The establishment of Vanguard sites signals one of the first steps in the implementation of the new care models that are described within the 5YFV.

 

Next steps

  • Consult with the regions to help understand the work which they are undertaking to develop successful integrated, highlight examples of best practice and share best practice.
  • To provide a general update, via the Bulletin, highlighting the work of the Task and Finish Group
  • Meet with Ian Dodge, Sam Jones and William Robert from NHS England to discuss making sure the different work streams e.g. quality and safeguarding are engaged with LAs and ADASS, and seeing how they expect the 5YFV to develop over the next six months.  
  • Organise follow up meetings with the LGA, NHS Confederation and NHS Providers