Management Forum April 2013 -

Management Forum
April 2013
John Bolton
Interim Executive Director
Management Forum
April 2013
Who am I …?
John Bolton – Qualified Social Worker
Director of Joint Review Team 1999-2001
Director at Coventry City Council 2001–07
Strategic Finance Director at Department of Health including
responsibilities for delivery of Putting People First 2007-10
Freelance consultant and visiting professor at the Institute for Public Care
– Oxford Brookes University
Interim Director in Warwickshire 2010 and Westminster 2011
Local Government Association Efficiency Programme 12/14 – work with
LAs on effective use of resources in England Wales and Scotland – written
many publications
… and what am I doing here?
Build on the success of Adult Social Care in Walsall and make it fit for
the future
Deal with any fallout arising from the suspension of Paul Davies et al
Ensure that the Directorate is running efficiently and effectively
Move forward on the journey to personalisation
Develop the programme of preventive interventions
Assist the Directorate to identify its contributions to corporate savings
I expect to be here for at least 6 months – probably longer
What is good about Walsall?
 Has a good range of services and strategies that ought to be fit to
assist with getting the right outcomes for local people
 Partner organisations that want to work with us
 Good investment in some preventive services
 A group of competent managers for their own services
 Streets Corner as a hub for new contacts – build on it
 Progress in thinking about personalisation
 Focus on quality
 Financial stability (at present)
 Generally a good environment in which to work
What might need to improve?
 Managers who can work together across divisions and service lines
– commissioners and care managers and providers
– Focus on shared outcomes
– Clarity about roles and responsibilities and overlaps
 Service users need fewer hand-offs, fewer assessments
 Personalisation – less bureaucratic, more outcome focused
 Getting the flow of people in and out of the care system
 Focus on promoting independence and prevention
 Clarity on the care market that we need
 Using PARIS properly at all levels
– Performance and outcomes for every intervention
– Using the data to help manage the business
Introducing some new developments
A focus on outcomes that promote independence
Personal Budgets (not Individual Budgets)
Either a Direct Payment (support available) or a Managed Account – straight
Support Plan
Focus on the outcomes to be delivered
Assessment – only carried out when preventive interventions have failed –
should lead to a support plan
Hospital – not the place to do an assessment for a long-term service – need
no delays
What is prevention?
• Universal provision
Community based services which people need assistance to access
• Preventative provision
Services that are for people who have some needs but not critical enough to
warrant an assessed social care intervention – Supporting People
• Recovery-based Services
Services that are supporting recovery, rehabilitation, recuperation and
rehabilitation which are offered people for whom, if they are successful, they
will reduce the need for high intensity care – Reablement or Recovery
• Deferred interventions
Services that are preventative in that they defer people for a time from a
poorer outcome and for the need for more intensive care. Dementia Care
The front end of the Directorate …
All Services that
address issues that
assist people in
being diverted
away from any
direct help from
social care.
supporting people
and community
teams with
community alarms
et al.
Interventions that help
people short term who are
in a crisis – the aim of these
services is to help people
short term to regain as
much independence as is
possible. Includes
intermediate Care/
Reablement/ IAPT –
counselling services/welfare
promoting independence
and employment/ telecare .
Main skills are OTs and
some social workers
Hospital Social Work Service
is in this area e.g. Helping
Older People and carers in
living with dementia.
Safeguarding is an
For those people who are
deemed to need an
assessment because they may
be eligible for longer term
support and other
interventions have not (yet)
Some of the interventions may
be assessed as continuation of
Short-term Intervention
The RAS operates here and
only option is a PB – the
brokerage function
First place where residential
care can be assessed.
… and the back end
Long term Care
People who need long
term help including those
with complex needs –
includes reviews of any
person who receives an
existing care package.
Reviews should always
consider whether the
initial intervention has
achieved its set outcome
and whether there are
better ways of delivering
any further needs.
Access to longer term
all of which has been
commissioned and procured
by JCU and is contract
managed for outcomes
Personal Budgets
Direct Payments –
supported by external
Managed Accounts –
brokered and managed inhouse.
Social care has a legal duty to assess people’s needs and
decide if they are entitled to services. Advice and
signposting are available to people who are not eligible.
Eligible people complete a self assessment which helps
them to work out for themselves what support they need to
achieve their outcomes. Together with an assessment
completed by a social worker, this generates an individual
budget - the sum of money people can have to meet their
needs and outcomes.
 Questions and Discussion
The financial strategy ahead
Likely scenario of £15 million+ less in 3 years’ time
We can manage demand better (prevention)
If prevention works – what will demand look like?
We can manage costs better (the level of care or the costs of care)
Reduced use of residential care could save money?
Can we save money from H21 contract or res care?
Should we out-source current in-house services?
We can increase charging (transport) or collection of charges
If this doesn't deliver, from where would we reduce staffing?
Group Exercise
 From where might you find savings for the next 3 years?
Managing demand
Managing costs
Raising income
Reducing staffing and infrastructure costs

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