Overview

The Adults module is divided into four sections

The first section; 'Key Questions', is a set of questions which are designed to help councillors and managers analyse the underlying reasons for their budget pressures, and to look for solutions.

The second section; 'How to Manage Demand' looks at how eligibility criteria and effective care management processes can be used to target services effectively. It also highlights the importance of maximising income, and shows how accurate management information and managing financial risks are crucial to good management of adults' resources.

The third section; 'How to Manage Supply' considers how to use the commissioning process to develop a range of services that maximise independence. At the same time it looks at some of the most cost effective ways of providing services for those who need high levels of care. This section links closely with other modules in the Making Ends Meet Toolkit (Commissioning, Partnerships and Financial Management). It also considers how social services can work with other local services to help older people, people with disabilities and those with ill health participate in the mainstream community activities. This is not only part of a social inclusion agenda, but also a means of reducing the demand for specialist provision and promoting prevention.

The fourth section; 'Sources' provides a variety of good practice examples and some direct links to other sites for those wanting to access more specialist information about particular areas.

In 2002/3 local authorities in England planned to spend on average 72.6 per cent of their social services budget on services for older people and vulnerable adults.

Managing these budgets presents significant challenges, particularly at a time when demand and costs are rising. Factors contributing to this include:

• Demographic pressures as more people live longer
• Changing needs and expectations of users and carers
• Volatility in supply resulting in shortfalls and higher costs particularly for residential and domiciliary care
• Improving standards and the rising costs of care for residential, domiciliary and day provision
• Variations in patterns of demand in different user groups resulting in;
  • High volume high turnover in services for older people
  • Low turnover, long term commitment and potentially high cost for services for people with significant disabilities
  • The high volume of budget decisions, financial transactions and changes in the level of financial commitments make tracking the adult services budget a complex and ever changing process.

Experience from Joint Reviews suggests that the most effective ways of offering a range of services are those which start with prevention and low level interventions. This can minimise the demand for high intervention and high cost services. However, getting and maintaining low level services is often problematic, particularly at a time when a number of authorities are having to grapple with significant overspends in adult care which can result in service cuts.

Recent changes in legislation have added to this complexity:

• Preserved Rights - local authorities are now responsible for the financial support of people placed in residential and nursing homes before the community care reforms
• Supporting People - local authorities also administer the fund to meet the support costs of people in sheltered accommodation
• Fairer Charging - Central government has introduced guidance on how local authorities charge for community care services from 2003. This includes a requirement to complete a full financial assessment if service users are asked to make a contribution
• Community Care (Delayed Transfers etc) Act introduces in England from January 2004 the requirement for local authorities to reimburse the health service for delayed transfer of care.
• Direct Payments The Community Care (Direct Payments) Act 1996 provided permissive powers. The Health and Social Care Act 2001 (Section 57),made it obligatory to offer direct payments in England for all adult users. New guidance was issued in September 2003 and can be accessed through the Department of Health Direct Payments webpage. Similar arrangements are proposed to be introduced in Wales during 2004.

Users and carers influence the overall direction of travel in services for adults as they have rising expectations of:

• a choice in the sort of services they are offered
• individual packages that reflect their needs, not the sort of services that happen to be available
• services that can be accessed promptly at times of need
• services that respect culture and traditions
• a significant voice in the planning and development of services

This module offers help on how to get the best out of the resources available in adult services. It contains examples and good practice advice to show that good outcomes for people can be achieved at the same time as value for money (See Exhibit 1).