Appendix 1 - the National Context

Appendix 1 - The National Context

There is clear consensus on the need for radical and ambitious social care reform, and a growing realization that boundaries between health and social care can be problematic for people who require community based support. Adult Social care has thus attracted a considerable amount of legislation, and policy and procedural guidelines- some generic, and some specific to adult social care. Specific Legislation, policy and procedures are outlined below.

1.1 Key (recent) Legislation

Health and Social Care Act 2012

The Health and Social Care Act 2012 restructures the NHS, abolishing NHS primary care trusts (PCTs) and Strategic Health Authorities (SHAs) and transferring purchasing powers to "clinical commissioning groups lead by general practitioners (GPs) in England, and local Councils take on the public health facility.

Health and Social Care Act 2008

The Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services, with tough new powers to ensure safe and high quality services. It also introduced a new form of professional regulation and strengthened clinical governance..

The Public Services (Social Value) Act 2012

Received royal assent on the 8th March 2012. The Act’s purpose is to require public authorities to have regard to ‘economic, social and environmental well-being in connection with public services contracts and for connected purposes. All public authorities are now required to consider, prior to undertaking the procurement process, how any services procured (whether covered by the Public Contracts Regulations 2006 or otherwise) might improve the economic, social and environmental well-being in areas which that public authority exercise sits functions. Furthermore it must consider how it can secure such improvements as part of the process.

This legislation is complementary to the public sector duties under the Equality Act (2000). The kinds of implications has could be far reaching. It could mean that a mental health service is delivered by an organisation that actively employs people with a history of mental health problems to help deliver the service – the social value of commissioning these services being partly related to the person with mental health problems having a job. Housing services could choose to provide greater social value by promoting careers through construction and trades contracts. Whilst it was possible for public authorities to include such elements within public contracts (and conduct procurement activities with such elements in mind).

1.2 Forthcoming Legislation

Care and Support White Paper July 2012

The draft Care and Support Bill creates a single law for adult care and support, replacing more than a dozen different pieces of legislation and provides the legal framework for putting into action some of the main principles of the White Paper, ‘Caring for our future: reforming care and support’,and also includes some health measures.

1.3Best Practice/ Procedural Guidelines

Government policy of 21st century has emphasised the need to help people to live independent lives giving them better choice and control. “Putting People First “(2007) was its first paper, setting out the following themes:

•Facilitating access to universal services

•Building on social capital within local communities

•Making a strategic shift to prevention early intervention

•Ensuring people have greater choice and control over meeting their needs

More recently this guidance has been further detailed and developed, and absorbed in an increasing number of performance measures for local authorities. It was followed in November 2010 by

A Vision for Adult Social Care: Capable Communities and Active Citizens

"A vision for adult social care: Capable communities and active citizens “set out how the Government wishes to see services delivered for people; a new direction for adult social care, putting personalised services and outcomes centre stage. The Vision for a modern system of social care is built on seven principles:

Prevention – Empowered people and strong communities will work together to maintain independence.

Personalisation – allowing people to take control of their care.

Plurality and Partnership – ensure there is arch and divergent mix of provision of high quality.

Protection – There are robust safeguards against the risk of abuse or neglect.

Productivity – there is a focus on the local authority identifying value for money comparing the cost effective’s ness of care services, and comparative interventions enabling higher productivity and high quality care and support services.

People – the social care workforce are supported and trained to deliver outcome focussed personalised care packages, and personalised services

Partly as a response to the above, in January 2011 the following was produced:

Think Local Act Personal

Think Local, Act Personal is a sector-wide statement of intent that makes the link between the government’s new vision for social care and Putting People First and gives a way forward for personalisation and community-based support.

It asserts that councils, health bodies and providers need to work more collaboratively to personalise and integrate service delivery across health and adult social care; and make vital public funding go further. It also recognises the contribution that individuals, families, carers and communities make in providing care and support – both to those who are publicly funded and those who either pay for themselves or rely on family carers.

1.4 Integral Policy Papers

“Under Pressure, a report by The Audit Commission in February 2010 states councils must balance the need to provide social care and to support active aging, and warns if care service provision is increased alongside population growth, public spending on care services could nearly double between 2010 and 2026. Private spending on social care would increase from £5.3 billion to £23 billion over the same period, if trends in means testing and self-funding continue. It notes that 85% of older people do not use council care services, but may use other services such as housing, leisure and adult education, that play an important role in keeping them active and independent; and they use a full range of general council services.

Tighter finances create an opportunity to rethink and redesign services to improve lives, while spending less public money. The challenge of an aging population is a challenge for the whole council, not just adult social care services.

Financial implications for local authorities of an ageing population’ (October 2009) by the audit commission, looked at the costs of older peoples social care. It identified that there is no significant correlation between the Care Quality Commission (CQC) inspection ratings and the level of spend. Councils that spent more didn’t necessarily get better ratings. Spending more in home care did not mean that authorities spent less in residential.

Use of Resources (2009 Department of Health) notes that a local authority should:

•Demonstrate how they have given priority for adult social care within other priorities

•Define how resources have been allocated

•Understand their patterns of spend and service costs, and manage its resources to deliver good quality outcomes and meet predicted demands by commissioning services at an affordable cost

•Have a range of services to support people to live in their own homes

•Achieve efficiencies through a system focused on early intervention, prevention and re-ablement and personalisation of services

Making a strategic shift to prevention and early intervention (the Department of Health 2009) states that local authorities should be demonstrating improvements in performance to meet the demand for low level services, that are said to be the key to offer real, community alternatives to people having to go into residential care, due to impoverished or absent community facilities and care at home services.

Social care transformation has been a key concept for national government, and continues as the government still ponders the next steps for the future of Adult social care. The future funding of the increasing numbers of older people that will need care and support is a major government concern. Many of the recommendations of the report by Andrew Dilnot – Fairer Care Funding Report (July 2011) have been accepted by the Government as set out in Caring for our future: progress report on funding reform (July 2012).

"Living well with dementia - a National Dementia Strategy" was published in February 2009. It set out a vision for transforming dementia services with the aim of achieving better awareness of dementia, early diagnosis and high quality treatment at whatever stage of the illness and in whatever setting.

Appendix 2 - Current use of resources

2.1 Adult Social Care Outcomes

The performance of local authorities, with respect to adult social care outcomes, is assessed on a new framework. It provides information that can be used to compare performance between local authorities. This information shows areas where focus and improvement are needed, as well as areas of good performance. The following is information from February 2013 Adult Social Care Outcomes Framework

Measure / Doncaster / Yorks & Humber average / England average / All England
Highest score / Lowest score
Social care-related quality of life / 18.7 / 18.7 / 18.7 / 20.1 / 17.4
the proportion of people who use services who have control over their daily life / 76.4% / 76% / 75.1% / 82.7% / 62.5%.
Proportion of people using social care who receive self-directed support and those receiving direct payments / 47.4% / 47.1% / 43% / 89% / 3.9%
Proportion of people using social care who receive self-directed support and those receiving direct payments (direct payments only) / 9% / 12.7% / 13.7% / 43% / 3.9%
Proportion of adults with learning disabilities in paid employment / 7% / 6.8% / 7.2% / 25.8% / 0.9%
Proportion of adults in contact with secondary mental health services in paid employment / 5.3% / 8.1% / 8% / 25% / 1.5%
Proportion of adults with learning disabilities who live in their own home or with their family / 70.6% / 76.4% / 70.2% / 95.9% / 21.9%
Proportion of adults in contact with secondary mental health services living independently, with or without support / 61.8% / 57.9% / 57.8% / 92.6% / 0.9%
Permanent admissions to residential and nursing care homes, per 100,000 populations (18-64 only) / 18.7 / 12.7 / 18.9 / 66.6 / 4.1
Permanent admissions to residential and nursing care homes, per 100,000 populations (65+ only) / 933.6 / 683.6 / 707.1 / 1269.1 / 86.4
Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services / 56.9% / 84.9% / 82.6% / 100% / 56.9%
Delayed transfers of care from hospital per 100,000 populations / 12.2 / 7.8 / 9.8 / 31 / 0.5
Delayed transfers of care from hospital, those which are attributable to adult social care / 6.7 / 2.2 / 3.8 / 16 / 0.3
Overall satisfaction of people who use service with their care and support / 60.5% / 63.4% / 62.8% / 77.7% / 47.3%
The proportion of people who use services and carers who find it easy to find information about services / 77.6% / 73.5% / 73.9% / 85.5% / 62.2%
The proportion of people who use services who feel safe / 62.3% / 63.2% / 63.8% / 86.2% / 49.2%
The proportion of people who use services who say that those services have made them feel safe and secure / 78.4% / 75.7% / 75.3% / 92.5% / 54.4%

2.2 How the budget is spent

In the last financial year (2012/13) Doncaster Council spent approximately £109.5m on Adult Services, including care, support, assessment and care management and support services. The following table sets out the main areas of spend, together with the breakdown between in-house and external provision. There are some areas of overlap between classes of expenditure, for example between older people and people with learning disabilities.

Sum of Revised Actuals 2012/13 / Column Labels
Row Labels / In house provision / External provisions / Income / Grand Total
*Assessment & care management / 9,270,956 / 514,443 / -908,904 / 8,876,494
All Client Types / 9,270,956 / 514,443 / -908,904 / 8,876,494
Care Home placements / 11,661,098 / 35,097,081 / -23,184,743 / 23,573,436
LD / 2,166,774 / 8,608,080 / -4,843,106 / 5,931,748
MH U65 / 670,103 / -123,724 / 546,379
OP / 8,432,580 / 24,984,906 / -17,907,974 / 15,509,512
PD / 1,061,743 / 833,993 / -309,939 / 1,585,797
Community equipment / 429,755 / 2,813,269 / -1,647,286 / 1,595,738
All Client Types / 429,755 / 2,813,269 / -1,647,286 / 1,595,738
Day Care / 5,235,911 / 1,989,394 / -1,755,850 / 5,469,455
LD / 3,507,809 / 1,281,162 / -1,513,075 / 3,275,896
MH U65 / 90,747 / 90,747
OP / 1,728,103 / 617,485 / -242,775 / 2,102,812
Domicilary care / 3,415,772 / 1,749,792 / -2,249,937 / 2,915,627
All Client Types / -1,717,697 / -1,717,697
LD / 175,230 / 8,342 / 183,572
MH U65 / 22,035 / 22,035
OP / 3,240,541 / 1,618,196 / -532,240 / 4,326,497
PD / 101,220 / 101,220
**Other services / 7,107,247 / 2,704,391 / -3,250,490 / 6,561,148
All Client Types / 7,107,247 / 2,704,391 / -3,250,490 / 6,561,148
Supported living / 965,459 / 9,423,123 / -5,780,181 / 4,608,401
LD / 965,459 / 9,423,123 / -5,780,181 / 4,608,401
Individual Budgets / 13,142,587 / -4,888,954 / 8,253,632
All Client Types / 158,550 / -1,127,770 / -969,220
LD / 1,273,528 / -199,271 / 1,074,258
MH U65 / 30,351 / -13,162 / 17,189
OP / 8,235,376 / -3,181,699 / 5,053,677
PD / 3,444,781 / -367,053 / 3,077,728
Supporting People / 6,878,523 / 6,878,523
All Client Types / 6,878,523 / 6,878,523
Grand Total / 38,086,198 / 74,312,602 / -43,666,345 / 68,732,455

*Includes all Social Work staff, Occupational Therapy staff and Administration staff

**Includes Carer Services, Preventative technology, Commissioning Team, Contracts Team, Assessment Unit, Adult Protection

The major spend within last year’s budget for 2011/12 was on care homes. Doncaster has proportionately more people in care homes than its comparator authorities and compared to the England average. This is reflected in the Council’s spend on residential care.

Appendix 3

Commissioning in Doncaster

The Commissioning cycle in Doncaster

It is the Commissioner’s aim to recognise, share and develop where resources are being well used and where, in the future, there needs to be greater focus and development. The local approach to commissioning has at its very heart the people of Doncaster and has been mapped to show how this process will be put into effect.

NHS Clinical Commissioning Groups are being established as part of the national changes to the NHS and there will be close working between strategic partners to ensure that pre-existing strong commissioning relationships with NHS Doncaster will continue as the new NHS takes shape. These relationships will be taken to a new level by negotiating and agreeing the most appropriate strategic lead for different commissioning priorities across social care and health.

These relationships and arrangements form the basis of the new Health and Wellbeing Board. It is anticipated that the Board will oversee a new commissioning culture with strengthened consultation and engagement networks to ensure that public involvement has a greater focus and impact on service development and commissioning. Adult Social Care commissioners will develop a dialogue between existing partnership boards and the Health and Wellbeing Board to ensure that local people and groups influence the emergent Health and Social Care agenda.

The local Health and Wellbeing strategy has been developed and sets out how Doncaster Council will work with partners, the public and communities to support independence and wellbeing. The key themes and outcomes of this Adult Social Care Commissioning Strategy are linked to the priorities identified in the Health and Wellbeing Strategy

What is already known about Doncaster

Available data and information highlights the need to work across the spectrum of the Adults and Communities Directorate to ensure that the people of Doncaster have the best possible outcomes in terms of independence and wellbeing:

• In line with national demographic trends, Doncaster’s ageing population is rising which poses a significant challenge in terms of health and social care provision
• There are currently 50,000 people over the age of 64 in Doncaster, by 2020 this will have increased to 60,800
• Some parts of Doncaster have larger than average numbers of older people living on low incomes
• Alongside an ageing population, Doncaster will have a greater number of people with dementia and other mental health issues associated with old age
• The numbers of falls amongst older people is likely to increase, as a result of increasing numbers of older people living in the Borough
• People and their carers generally think it is easy to find information about services which they use. Although this is not the case for all client groups, it appears to be less easy for those with a Learning Disability, Physical Disability or a Mental Health problem
• Permanent admissions to residential and nursing homes are higher than the national average
• The number of people, ages 65+ who are still at home 91 days after discharge from hospital is lower than the national average
• Feelings of insecurity amongst those who use services are mostly felt by those who are older and have a physical disability

Appendix 4 - Demographic and Deprivation Factors

The Department of Health has developed some projections about the future needs of the local population in Doncaster[1]:

The number of people aged 65 and over will increase from 53,000 in 2012 to 61,200 in 2020.

• The number of people aged 65 and over and classified as moderate which means they areunable to ‘manage at least one self-care activity on their own’ will increase from 17,639 in 2012 to 20,504 in 2020

• Around 3,600 people aged 65 and over currently have dementia, this is approximately 7%. By 2020 this is projected to rise to 4,317

• More older people aged 65 and over, and 85 and over are in care home accommodation than in neighboring Yorkshire and Humber authorities, and in England, per 10,000 population, and per 1,000 people age 65

• The number of people aged 65 and over living alone will rise from 7,200 to 8,240 by 2020

• The number of people with a sensory impairment will rise from 28,986 in 2012 to 33,656 by 2020

• The number of people aged 18-64 affected by mental health issues will fall slightly over the next 10years. However the numbers of older people with depression is likely to rise as the older population increases

• There are around 14,600 people aged 18-64 with a moderate physical disability in Doncaster and another 4,300 with a serious physical disability

• There is a relatively small (8.2%) minority ethnic population with the biggest change in the ethnic make up being a rise in Polish and other East European nationalities. The number of gypsy/travellers resident at any time in the borough is between 4,000 and 6,000

• Overall the number of people with a learning disability is set to decrease slightly. However within that number, people with a severe learning disability who are likely to need more care is estimated to increase slightly. Support for people with autism is likely to increase as more people with autism are identified, assessed and supported

• Carers receiving services in 2012 is around 1,250. For carers over 64 the number in 2012 is 916 and is projected to rise to 1,266 by 2030

Doncaster Index of Multiple Deprivation