By Debbie le Quesne

Directors trying to grasp the nettle of deeper cuts

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After a night’s sleep, coffee, golf and the therapy of good company I’ve return to the ADASS Budget Survey 2015. Help!

The big question we’re all asking is how more savings in the industry can be made. It’s a question that’s been lobbied in Parliament and the offices of Whitehall and the responses have been . . . poor.

However, local authority directors are now attempting to grasp the nettle and in responding to the question of how they would make savings, for both 2015/16 and for 2016/17 onwards.

This is their published reply: “Directors report increasing reliance upon integration in making savings going forward (71 per cent as from 2016/17 onwards), and a continued focus upon early intervention and prevention (73 per cent as from 2016/17 onwards).

“There is also an increasing emphasis upon what was described as stopping ‘unnecessary’ services and shifting activity to cheaper settings, along with better procurement.

“The majority of Directors do not see controlling wages or increasing charges as areas of importance in making future savings. This can be explained by firstly that most of adult social care budgets are spent with external providers, many of whom pay staff at or close to the minimum wage and therefore decisions about the level of the minimum are not within the control of local authorities nor providers; and secondly, the survey analysis illustrates that there is limit to how much further councils can increase charges.

“On the contrary, the majority of Directors have reported that wage pressures are key drivers for increased costs of residential & nursing care and home care services in 2015/16.”

Are we all clear on that? Well, not really, Integration reliance – I’m assuming integrated care – is as fantastic concept for efficiency and good delivery of care. It’s joined-up thinking with all care elements coordinated and seamlessly meshing together.

The World Health Organisation noted last year, however, the initial problem of carving up the monies is one of definition.

“A key challenge,” it said in its What is the evidence on the economic impacts of integrated care? document, “remains the lack of common definitions of underlying concepts; as a consequence there is a plethora of terminologies that have variously been described as ‘integrated care’, ‘coordinated care’, ‘collaborative care’, ‘managed care’, ‘disease management’, ‘case management’, ‘health/ social care service user-centred care’, ‘chronic care’, ‘continuity of care’, ‘seamless care’ and others.”

It’s true. Until the borders are care streams are defined – of what’s in, and what’s out – the arguments over who gets what in the budged pool will remain.

And finally (for now). . . How confident are the Directors in making further savings?

Whilst 45 percent of Directors were fully confident that planned savings for 2015/16 would be met, this confidence falls sharply away beyond 2015/16 to only five per cent being fully confident that savings will be met in 2017/18.”

More coffee, please!

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