Why the Government can’t have it both ways…

Proposed Future Model of Adult Social Care in Nottinghamshire

(Consultation period until 20^th Dec 2013)

The combination of growing demand for social care services from an increasingly frail elderly population and people with long term conditions, taken together with a second round of severe budget cuts forced upon the County Council, make it less and less likely that adult social care will be able to meet the spirit and the letter of the government’s expectations expressed in the national 2014/15 Adult Social Care Outcomes Framework. (http://ascof.hscic.gov.uk)

For the County Council this represents a real challenge.  In response it is consulting on its “Proposed Future Model for Adult Social Care” (http://www.nottinghamshire.gov.uk/socialcaremodel) which is intended to bring about further efficiencies and economies in the County’s social care services.

However, Healthwatch Nottinghamshire’s view is that this will lead to a widening gap between the Department of Health’s rhetoric and the realities on the ground. It is instructive to compare some of the demands of social care outcomes with the reductions in adult social care being proposed for Nottinghamshire over the period 2014-17

Domain One (from the national framework) – “Ensuring quality of life for people with care and support needs”  

With an outcome measure:  “People manage their own support as much as they wish, so that they are in control of what, how and when support is delivered to match their needs”

If we take just three of the options now being considered it seems clear that these cuts begin to erode the possibility of meeting even the “letter” of this domain, let alone the “spirit”.

• A formal policy is now proposed whereby service users (and by extension – their families and relatives) will be expected to pay the difference for care and support which is more expensive than the alternative care that can be procured by the Council. For example, where a service user has a home-based package of care which costs more than the average residential care home they might have to pay the difference in the care costs, or move to residential care

• Another proposal is to reduce the average community care personal budget for younger adults (aged 18-65: learning disabilities, physical disabilities, mental ill-health and aspergers). Such a budget reduction would inevitably impinge on the ability of service users to achieve the quality of life expected by the Department. How could it not?

• What will be the impact of a proposed 10% reduction in social work staff working in older people’s assessment teams (in the community and in our hospitals) whilst increasing the role of the Nottinghamshire County Council’s  Customer Service Centre in telephone assessment and signposting?  Whilst there’s some merit in the latter idea, it must inevitably lead to a reduction in the valued face-to-face contact with vulnerable older people in their own homes.

Domain two – “Delaying and reducing the need for care and support”

This relates to the idea that “prevention is better than cure”.  All of us (the government, local government, public health, the NHS and the general public) believe this to be sensible and rational  in order to help people who are becoming vulnerable from needing more intensive and expensive interventions later.

That is the rhetoric.  What is the pressure on the County Council budget leading to on the ground?

• One proposal is to cut the remains of that part of the Supporting People budget designed to provide accommodation and support to homeless people across Nottinghamshire. If enacted this will lead to the closure of all direct access homelessness facilities with the immediate consequence of increasing the number of rough sleepers to a much higher level.

• Prevention and early intervention services, located in Nottinghamshire’s diverse voluntary and community sector, already took a severe hit at the last round of enforced budgets cuts in 2011. In 2011/12 34% had to be sliced off grant aid to the voluntary sector to provide just these sorts of preventative services.

• Intermediate Care is designed to help older people return home safely from hospital or prevent unnecessary hospital admission.  If the budget for this is reduced by 26% it will be counter- productive for achieving the outcome of “delaying and reducing the need for care and support”.

Domain Three – “Ensuring that people have a positive experience of care and support”

With an outcome measure: “People know what choices are available to them locally, what they are entitled to, and who to contact when they need help”.

The “personalisation” approach the government wants to see adopted across all health and social care services requires that patients and service users have some choice and control in the services they are offered.  The reality of the proposed cuts below, just two of the many others now being considered, describes a reality on the ground that is becoming a far cry from that.

• Day services for people with learning disabilities, physical disabilities, mental ill-health and older people (some with dementia) may face a reduction in number of centres and their availability. This could impact upon some 18% of current service users and inevitable lead to greater restriction of choice.

• The proposal to reduce adult social care’s own short breaks provision for younger adults with learning disability and their carers will reduce choice and availability of dates for those using the remaining facilities. The Department acknowledges that ”young people transferring to adult services may not receive the same level of support through residential breaks as they have been used to in Children’s services”.

The County Council is consulting on this proposed future model of adult social care up to the 20^th of December.  The wider budget cuts of £154m to be brought in for 2014-5 in the “Budget Challenge” (http://www.nottinghamshire.gov.uk/thecouncil/democracy/have-your-say/consultation), and which will incorporate some of the proposals highlighted here, are open for consultation until County Council Committee meets.  It will be making what will be unenviable and difficult decisions on January 17^th 2014.

It’s good that Nottinghamshire County Council has decided to go out for consultation on what it describes as “this bleak picture” of budget reductions so early. Many other Councils haven’t done as much to try and gauge the public mood, or consulted on where the social care cuts should be made.

But the disconnect between national Department of Health expectations and the realities on the ground are becoming evident.  This disconnect becomes even more startling and unreal when you consider that the government proposes to put peoples’ “wellbeing” into the heart of the new care system!!

The government can’t have it both ways: they can’t have their cuts of Local Authority social care budgets and have their Adult Social Care Outcomes Framework too.

SO:

Please HAVE YOUR SAY on this consultation by visiting http://www.nottinghamshire.gov.uk/socialcaremodel

Health and Wellbeing Strategy for Nottinghamshire (with a nod to the Dalai Lama)

Out for consultation until Sept 26^th

Have your say…..

• What is “health and wellbeing”?
• Why is it important? (What did the Dalai Lama say?)
• What’s being consulted on?
• What is Healthwatch Nottinghamshire’s role?

What is “health and wellbeing”?

It’s well put in the opening lines of Nottinghamshire’s draft strategy:

“Health is often stated as being an absence of illness or disability.  However, health and wellbeing recognises that a person’s overall feeling of “wellness” includes a sense of physical, mental and social wellbeing and therefore, takes a much wider view of what effects a person’s life experience”

So, health and wellbeing is no longer just about illness, hospitals, doctors, nurses and therapists. The Nottinghamshire strategy takes a much wider view. For example priority 7 (N.B. this is my numbering, they’re not numbered in the draft!) is about safeguarding children, young people and vulnerable adults from abuse.  Another example is priority 9, concerned with improving the quality and affordability of housing in the County – a pretty crucial determinant of health and wellbeing. But this is a Council function and not contained in NHS budgets!

That is where this strategy is different – to be effective it is going to have to cut across different organisations’ individual plans and priorities. This is going to challenge the instinctive reluctance of Health, Councils and the other major agencies to leave their organisational silos. This may prove to be particularly difficult at a time when their budgets are under pressure as never before.  So is it going to be a “close down the hatches” reaction for 2013-15 or, alternatively, can we set out for the more uncharted waters of, as the Cllr Bosnjak, Chair of the Health and Wellbeing Board, describes it:

“The common purpose to work across health, social care and wider communities to improve health and wellbeing opportunities for all”.

Success is going to depend on close working between local government, the NHS, the community and voluntary sector, and independent organisations.

Why is it important?

The Dalai Llama spent a week in Nottinghamshire in 2008 where he was warmly welcomed by County Councillors.  It was a sight to behold: The leader of Tibetan Buddhism strolling down the river Trent Embankment in his red monkish robes with, on each side of him, and his arm firmly through each of their arms, the two women who were then local democratic leaders of Nottinghamshire County Council – Cllr Joan Taylor (Chair) and the Vice Chair, Cllr Ellie Lodziak. The contentment on the Councillors’ faces was palpable.

The Dalai Lama has an interesting take on how we are doing in the West in terms of wellbeing. This is taken from his piece called, “The Paradox of our Age”:

“We have:

More conveniences, but less time;

We have degrees but less sense;

More knowledge but less judgement;

More experts, but more problems;

More medicine, but less healthiness.

We’ve been to the moon and back

But have trouble crossing the street to meet the new neighbour”

 Everyone in Nottinghamshire should be able to enjoy good health and wellbeing but we all know from experience, and it is evidenced in the Joint Strategic Needs Assessment (JSNA), that some groups and communities in the County experience poorer health and wellbeing than others.  The strategy, if it is to be effective, needs to make an impact on these inequalities by placing an emphasis on the most vulnerable and those who have the poorest health.

What’s being consulted on?

There are 3 themes or principles in the strategy:

• Prevention and early intervention
• Supporting independence
• Promoting integration across partners

Under those three there are 16 priorities (you can find what they are at http://www.nottinghamshire.gov.uk/caring/yourhealth/developing-health-services/health-and-wellbeing-board/strategy/)

Do you agree with these 3 underlying themes that shape the overall strategy?
Is there anything in there that you don’t think should be a priority, or there is an area of health and wellbeing that you think has been missed?

These are the ways you can feedback to the planners of the strategy:

• View the consultation document and complete a feedback form on the County Council Website (http://www.nottinghamshire.gov.uk/caring/yourhealth/developing-health-services/health-and-wellbeing-board/strategy/)
• Attend a consultation event, the remainder of which will take place on:

15 August 2013 (10am) at Retford Town Hall
9 September 2013 (10am) Richard Herrod Centre
10 September 2013 (6pm) Rushcliffe Arena
12 September 2013 (6pm) Ashfield Summit Centre
13 September 2013 (2pm) Bridge Community Centre, Newark

(Please book your place via joanne.stewardson@nottscc.gov.uk or 01623 433007)

What is Healthwatch Nottinghamshire’s role?

The strategy is important for Nottinghamshire people because it will influence commissioning decisions about services of the NHS, local government and social care from now all the way up to 2016.  We expect this Nottinghamshire strategy to be a “living document”, i.e. it is likely to develop and evolve over time.  We want the views of consumers coming into Healthwatch Nottinghamshire to contribute to the implementation of this strategy.

Healthwatch sits on the Health and Wellbeing Board, the “overseer” of this strategy. Healthwatch Nottinghamshire will exercise its responsibility on the Board by, amongst other things, keeping an eye on what patients, users and carers are saying about the services that sit under these 16 priorities.  Where necessary Healthwatch will make recommendations to the Board, or to health and social care commissioners, for changes or improvements to those services.

As part of our ongoing support to the strategy, Healthwatch will be attending all of the consultation events listed above. If you have something to say or simply want to learn more, come along and speak to us at one of the events or phone us on 0115 963 5179 and we’ll feed your views into the consultation process.