Sunday 28 November 2010

Next steps in Transforming Adult Social Care Services in Reading

The national independent regulator and inspectorate of adult social care services in England, the Care Quality Commission has concluded that Reading Borough Council's adult social care services are performing well. From the official Council press release published earlier this week:
'CQC inspectors who have been monitoring the performance of the Council's adult social care service, graded the Council as doing 'well' against all seven criteria.
The Council was given particular praise from CQC inspectors for consulting with residents on the range of adult social care services available in Reading and how they could or should be receiving them in order to improve their lives, maintaining dignity, independence and well-being.
Inspectors said the quality of residential and nursing care commissioned by the Council was predominantly good or excellent and welcomed the Council's increased investment in intermediate care, falls prevention and end of life care including a range of specialist services which are provided for people with long-term conditions.
Reading's adult social care service was also found to be progressing well with regard to its Putting People First initiative, by offering more personalised social care services, such as reablement.'
This is a fantastic achievement by staff working in adult social care in Reading. Adult social care services in Reading have been improving year on year and this is entirely down to the hard work of the staff working to support some of the most vulnerable in our community.
As Chair of the Housing,Health and Community Care Scrutiny Panel (2008-10) I led active cross-Party monitoring of adult social care performance, regularly challenging officers to do more to improve services, and arguing for things like adult safeguarding training for all councillors. There has been a commitment across all political parties in Reading to see these improvements delivered and this has clearly paid dividends in terms of a better service for residents we serve.
A week ago the Chief Executive of the Council and I presented awards to a large number of staff who have completed qualifications in social work and social care. We are very lucky to have such a dedicated social care workforce in Reading, as well as a Council committed to real workforce development, and I would like to thank all staff involved in adult social care for all the work they do for the community.
But the hard work and the challenges we face in social care do not end here. On Monday I will be presenting a paper to Cabinet about proposed next steps on the journey we are making towards transforming social care services in Reading. This is part of our committment to delivering high-quality, well funded adult social care services.
It will come as no surprise to anyone that in relation to social care we are faced with a number of challenges and given the number of people who receive our services in Reading (currently over four thousand) and the millions of pounds of public money the Council spends in this area I think it is important to be open about them as we seek to find solutions. Nationally, the need to reform social care funding system to reflect the impact of our increasing ageing population is well understood and next year the Commission into Funding of Social Care set up by the Coalition Government will report.
Paul Burstow MP, Lib Dem Minister for Care Services, indicated in the recently launched Vision for Social Care he is looking to go further than the previous Labour government's Putting People First agenda by expanding the number of people who have access to a personal budget, and increasing help for carers - both very welcome initiatives.
Locally the challenges we face in adult social care have been known about for some time (predating the local coalition), and include demographic pressures such as an increase older people and  in the number of people with complex needs approaching the Council for support, as well as increasing expectations from our residents for more personalised care. We must also respond to the need to extend support for our amazing community of unpaid carers in Reading who between them provide hundreds of hours of care to needy people each and every week.
In order to safeguard care and support for those in our community who need it most  (including carers) we must firstly ensure that our spending plans are sustainable by this I mean affordable and targeted on the right areas.
Under the previous Labour administration spending on social care outstripped the planned budget allocation practically every year. Labour politicians response to increasing demand for services  was to plug the funding gap this caused by ratcheting up Council Tax (increasing the burden on the elderly and those on fixed incomes) and raiding the Council's reserves. And they did this in full knowledge that demand would continue to rise and that the Labour government planned to make over £40bn worth of spending cuts after the general election! This is a completely unsustainable and if we continue down that road we will break the Council's budget. Failing to keep within our budget in future or failing to plan our future spending carefully could jeopardise care for the most vulnerable as it could force the Council to ration care. This would also undermine all the work we are doing to put people in charge of their care.
This is not a path I or my colleagues are willing to go down. So we must plan to live within our means as a Council, without placing extra burdens on the worst off, which means facing up to, and not ducking some tough decisions.
It goes without saying, therefore, that we must analyse every penny we spend to ensure we are getting value for money for services we buy, so that every pound we save we can reinvest in frontline care and support. A number of our  inhouse services are high cost compared to other local authorities and as custodians of public money we owe it to local residents to look at ways of tackling this. But simply doing things more efficiently will not be enough to protect social care services.
We need to do more to ensure our spending is sustainable and fair. For example, on Council home care charges. Under the policy we inherited from the previous Labour administration we currently subsidise people who have been assessed as being able to pay. Is this fair if it means that sfuture services to the vulnerable are threatened because our budget doesn't stretch far enough? I don't think so.
But it isn't just about what we spend public money on but how we spend it. We need to invest more in keeping people active, healthy and in their own homes. This is what older residents told the Council they wanted two years ago. And a recent survey of carers found they desperately wanted to be supported to get breaks.
But our plans also need to be flexible enough so that  for people with complex needs for conditions like dementia wehave the right number and type of beds available.
All of these challenges require  us to make changes to our current policies, hence we are required to take proposals through Cabinet and to involve the public in any future decisions.
On Monday I will be seeking Cabinet approval to go out to public consultation on our eligibility criteria for social care and our charging policy. Currently Reading is one of the few councils that continues to provide support for people classed as having 'greater moderate' needs. I understand why the Council has felt this was the right policy in previous years but times change and challenges we face will not go away. I am not suggesting that the Council stops helping people who need support but that we need to change our approach to ensure we protect the most vulnerable and invest in preventative care. This means:
  • We need to offer more support to  people to stay active and in their homes through reablement services help them avoid repeat visits to the hospital.
  • Local people want choice and control over their care so we need to work with a plurality of providers to meet local needs. In order to deliver more personalised care that is affordable we must accept that the Council cannot and should not have a monopoly on providing care: we have a thriving voluntary sector (which the Council actively supports through grant aid) as well as an army of carers, faith, and community groups we need to reach out to. .
If the proposed changes to Reading's eligibility criteria and charging policy are agreed in future, all existing adult social care clients would receive a personal review and financial assessment to determine how they could be best supported in the future.
  • People with the greatest need would still receive services from the Council and people with the least money, would not be required to contribute to the cost of their care.
  • The Council already offers a number of preventative services to support residents to live independently and improve their quality of life for longer. This ranges from providing sensors and alarms to help make residents feel safer in their own home, to the relatively new Reablement (intermediate care) intensive support programme, which aims to get people back on their feet and live independently within six weeks. The Coalition Government is committed to developing and extending these services.
  • The Council has also just launched a directory of services, which gives residents a wealth of information on local and national resources to find advice, support and activities to help people stay healthy, maintain independence and live life to the full.
  • Preventative services will be further enhanced through the Council's ongoing work with voluntary and community organisations to ensure residents are aware of and receive the broad range of support services that are available in Reading.
  • Carers will continue to be supported to ensure they get access to services and support they need
  • The Council will also work with residents to make sure they receive any benefits they are entitled to.
If the paper I table is approved by Cabinet we will be actively consulting the public and those whose who receive our services from December to February to find out what they think the balance should be on adult care services. I look forward to having that debate about how we  can continue to build high quality, sustainable social care services in Reading in future years.

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