Cllr Wayne Fitzgerald is the Deputy Leader and Cabinet Member for Integrated Health and Adult Social Care on Peterborough City Council.
Over the last 4 years the environment and context of meeting people’s “social care” needs in Peterborough has changed dramatically. The demand and expectation of services has risen dramatically, compounded by people living longer and often with more complex needs.
The local market has had to deal with intense financial pressure to reduce costs at a time where access to capital has tightened and the trend of consolidation or exiting has increased. Legislative changes have also had an impact on costs making it more difficult to deliver the council’s services these include the Care Act and the National Living Wage.
Our entire system is having to find ways to financially contract with over £500m of known pressures existing in the Cambridgeshire social care system as forecast over the next five years.
Until the end of the 2014/15 financial year our Adult Social Care (ASC) team had primarily focused on creating savings from existing budgets. This included re-negotiating fees with providers and re-tendering large contracts. As this strategy was starting to show diminishing returns, the focus changed in this year to a much broader strategy of investing in transformation and finding new, sustainable ways to manage demand and meet needs more effectively.
We have embarked on a three year transformation programme, supported by a £4m investment fund. The fund has been used to aggressively focus and invest in services that contribute to the delay and/or prevention of demand and keep people at home where at all possible, to build long term community capacity, and to align resources and integrate services with Health in a way that improves customer journeys whilst reducing duplication and cost shunting.
The performance since 2014/15 is shown below. (2017/18 is our latest forecast.)
- 2014/15 £3.2m ASC savings. £31.4m ASC budget.
- 2015/16 £9.3m ASC savings. £28.6m ASC budget.
- 2016/17 £8.4m ASC savings. £27.9m ASC budget.
- 2017/18 £6.6m ASC savings. £26.7m ASC budget.
In real terms our budget has reduced by £4.7m since 2014/15. Savings delivered amount to a whopping £27.5m, which when taken together, have mitigated demand and other pressures.
Whilst our transformation programme has made a significant contribution over the period, it too has diminishing returns. Demand is forecast to continue to increase and market forces expected to deteriorate.
More recently, the lack of availability of staff (social workers, nurses and carers) is also expected to have a material impact on capacity and the cost of services in the future. Examples include difficulties in recruiting staff to demand management and Early Intervention related services such as Reablement and Domiciliary Care.
The ASC team here is currently forecasting a further £4m of additional pressure in 2017/18; much of which is outside of their control. The key issue is that as the transformation programme reaches diminishing returns, the corresponding ability to meet these pressures is reduced.
This is potentially putting the service here in Peterborough at a tipping point of not being able to meet demand within current resources and plans without further and truly additional funding being made available. This scenario would have severe consequences for the rest of the system – with significant knock-on costs, particularly in Health and deterioration in people’s health and wellbeing.
Government really does need to take a long hard look at this national issue as it won’t go away and is only set to get worse if nothing is done for the long term.
It is my long held view that either through future devolution deals or a direct change in legislation that we should give all health and social care budgets to the combined local authority. Alternatively, remove social care as a statutory council responsibility and pass it over to health as the two will remain intertwined
I am comforted to know that because of our early start in tackling this issue we find ourselves in a better position financially than most in the UK including many of our near neighbours.