(pictured: Steve Wise, see below)
Birmingham has a plan to transform services that has started making savings, but the forthcoming spending review will put it in jeopardy, report Vern Pitt and Mithran Samuel
Like all local authorities, Birmingham Council has wrestled with the problem of delivering social care for a rising population of older and disabled people, with expectations of better and more personalised services.
This challenge has not gone away, but on 20 October, when the government’s spending review reports, Birmingham faces the prospect of meeting it with far less resources than it enjoys presently.
Staff at all levels, from directors to the frontline, are questioning whether the council can withstand real terms cuts of 25% or more from 2011-15 and meet the city’s rising social care needs (see boxes).
This is despite the successful implementation of a transformation programme, launched in 2007, to address the additional costs of demography and challenges of the personalisation agenda.
The council calculated that without reform it would need to spend an extra £290m on adult social care from 2008 to 2018. Its current adult care budget is about £300m a year. However, it found that it could generate savings of £230m over this 10-year period by transforming the way adult care was delivered, meaning spending would still have to rise but by far less than had been previously feared.
The transformation programme has several elements. Firstly it involves limiting and managing demand for care by using predictive tools to identify people who could benefit from preventive services such as telecare, and by providing short-term enablement services to help people regain independence following crisis.
Secondly, it involves empowering people to assess and meet their own needs through improved information and advice on services, and by introducing self-assessment and personal budgets, relieving the pressure on social workers to carry out assessments and manage people’s care. Allied to this is support to help people maximise their own incomes through benefits advice, reducing their dependency on the council.
Thirdly, the programme involves shaping the social care market to establish services that can meet the personalised needs of rising numbers of service users.
The programme is designed to have delivered £4.5m in savings from 2008-9 to 2010-11, and the council believes it can meet this interim target. The transformation programme assumes that savings increase year-on-year. However, this will become far more difficult to deliver if Birmingham’s adult social care capacity is cut by 25% or more over the next four years, leaving the council with few options beyond increasing eligibility thresholds or providing reduced funding for eligible users.
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Kathryn Smith, social worker, physical disabilities team; ‘Assessments for care are now being questioned on cost grounds’
There’s nothing revolutionary about the direction of travel to personalise care in Birmingham’s transformation programme, says social worker Kathryn Smith. She recalls talking about empowering service users and giving them choice when she qualified in 1994, and she supports the principles.
Training in a more personalised approach has served to improve practice, she says. However, some clients are less comfortable than others in taking more responsibility for meeting their own care needs. “The pace of change is unequal across the groups of people,” she says. “Some people feel that it is the local authority’s job to provide services and if you are disabled, sick or unwell you will be eligible for a certain amount.” But many have explored all the other options before they turn to the council, she adds.
She isn’t comfortable with having to break bad news, be this increased charges, restricted eligibility or other ways in which the council might choose to handle government cuts, but she is confident she can do it professionally.
Smith’s main worry is that her ability to do a good job will be endangered by cuts behind the scenes. She says Birmingham is set to cut team manager posts in adult care, and claims this could endanger one of the aims of the transformation programme by putting extra pressure on frontline staff. “One of the good things you want to keep about assessment is the focus on the person and their carer,” she says. “If you are being pressed and asked to do more then you may not be able to do that.”
Budgetary pressures are already affecting morale on the frontline. Increasingly, she says, social workers’ assessments for care are being questioned and driven down by budget holders. Smith fears this could become worse as the government takes its axe to council funding.
Glynis Hovell, director of specialist care, adults and communities directorate; ‘Little room for manoeuvre’
As director of specialist care, Glynis Hovell has a major part to play in transforming Birmingham Council’s social care provision.
She is responsible for the council’s enablement programme, which provides short-term support to help people regain independence and has been tasked with generating savings of £55m from 2008-18.
Hovell is confident she can increase the savings from enablement beyond those targeted by the council’s transformation programme but worries the pace of change demanded by prospective Treasury cuts is impossible. “It doesn’t allow much room for manoeuvre,” she says with a grimace.
This will have a huge impact on service users, she says. “Some service users have become quite dependent on us and they need time to make that change; removing something from someone can be quite difficult,” she says.
How her enablement service will pick up the pieces is unclear.
Steve Wise, service director (business change), adults and communities directorate: ‘We’re in need of some magic’
By the admission of Steve Wise, who is responsible for Birmingham’s adult care transformation programme, the council’s savings plans are ambitious. “Whether it will deliver those quite ambitious savings targets is yet to be tested in anger,” he says.
But the outcome of the government’s spending review will mean the council will have to make major changes on top of its transformation agenda, he warns.
Birmingham could see its adult care budget reduced by 30% from 2011-15, a reduction of £90m a year in today’s money.
Wise describes himself as a “solutions person” but he has no answer to how to deliver this level of saving. “Our entire staffing provision is £50m so you could diminish your staffing to zero and it still wouldn’t meet that,” he says.
He says he needs something magical and hopes the NHS might agree to contribute financially to keep services going.
“That’s quite a difficult conversation to have right now,” he explains.
This is because of the government’s plans to abolish primary care trusts and transfer their responsibilities to GP consortia by 2013.
“The PCT world is diminishing and the new GP world is not yet up and running and unable to deal with that responsibility [of pooled funding],” he says.
Referring to the government’s plans to devolve power over public services to local areas and citizens, he says: “Maybe the Big Society can help, maybe localism can help, but the pace of this [funding reduction] is really, really rapid and in my view you can’t get the alternative models of care in place [quickly enough] to deal with the fallout.”
He has real worries that this will in turn endanger the council’s transformation programme for adult care and Birmingham’s most vulnerable adults.
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This article is pubished in the 7 October 2010 issue of Community Care magazine under the heading Transformation in danger