National context

The government wants services to be responsive to local needs, promote independence and choice and are financially sustainable year-on-year.

The national policy documents, ‘Strong and Prosperous Communities: The Local Government White Paper’ and ‘Our Health, Our Care, Our Say’, the NHS and Social Care White paper set the direction. In summary, it is about high quality support, meeting people’s aspirations for independence, choice and greater control over their lives, making services flexible and responsive to individual needs and addressing causes not just the effects of difficulties through services that are preventive and support early intervention.

Other important drivers for change are the introduction of Practice Based Commissioning with its emphasis on strong clinical leadership and delegation of budgets to primary care practices and the new role for the Director of Adult Social Services (DASS)¹ which requires the DASS to:

• 'Champion the needs and aspirations of adults and promote wellbeing that goes beyond the organisational boundaries of adult social care. The DASS should also provide strong leadership and coordination in ensuring that local providers of mainstream public services recognise and meet the needs of individual adults with care needs and their carers…. to take a whole systems approach to providing care and supporting wellbeing.'

¹ Guidance on the Statutory Chief Officer Post of Director of Adult Social Services May 06
  Best Practice Guidance on the Role of the Director of Adult Social Services May 06

Local Context

Local services need to be able to respond to the changing needs, rurality, diversity and higher expectations of people in Devon.  People are living longer and often have more complex health, social care and housing and housing related support needs.  In Devon there is an established pattern of high levels of immigration of people in the older age groups.

Devon has a large number of people who are caring for family and friends and who play a major role in supporting people to remain living independently. We also have a growing number of people from minority ethnic groups often located in small/isolated areas across Devon.

Devon has areas of significant inequalities. We need to work differently to address the fact that demand is increasing at a greater pace than resources are likely to and to have effective and efficient delivery of services. Ensuring the public is fully engaged in our planning and that service users and carers are fully involved in their assessments and care plans are key to delivering the right care, at the right time, in the right place.

Managing and Delivering Change

Reshaping the way care is arranged and delivered is imperative to help us achieve the range and quality of care needed by the local population now and into the future. We will undertake a Joint Strategic Review with Devon Primary Care Trust to inform health and social care strategic direction and future priorities for improvements for the next 5 years.

We will improve timeliness of assessments, reduce duplication for service users and carers and become more responsive to requests for support by further integrating the health and social care workforce and by using new technology, We will also focus on identifying and responding to needs at an early stage and give high quality information to support health promotion and to assist people manage their health conditions.

We will continue to take forward county council requirements with a particular focus on: -

• Contributing to a Greener Devon by enabling staff to work flexibly where appropriate, use of mobile technology and requiring environmental standards as part of service commissioning and procurement;
• Setting equality targets and carrying out equality impact assessments;
• Contribute to the social inclusion agenda. Some examples are: -
  • working with the Hikmat centre to further develop its role;
  • working with the customer services centre to expand the range of information available;
  • taking forward the Senior Council for Devon;
  • Promoting equal opportunity policies and undertaking equality Impact assessments
• Improve services by monthly performance and financial reporting of key areas of activity, continuing to learn from customer feedback and by aligning staff objectives with organisational needs;

We will set up a Health and Wellbeing Partnership that goes beyond the organisational boundaries of adult health and social care which will be responsible for ensuring these improvements are delivered across Devon.

The budget set for Adult and Community Services for 2007/08 will be challenging, despite recognition by the County Council of the need for extra funding for increased social care needs.  Overall, including inflation, the budget has increased from £139.5m to £146.4, an increase of £6.9m or 4.9%.  There are challenging targets in all areas to make savings, including “green” savings and efficiency measures, while maintaining services to people in Devon. The challenge will be to contain spending to achieve financial balance in the face of extreme demand pressures.

The financial recovery plan for Learning Disability Services, with continued emphasis on improved commissioning processes and needs of individuals, is likely to present the greatest financial volatility and risk, but the achievement of its containment plan in the current year gives reason for confidence in the delivery of this essential part of the Directorate’s plans for 2007/08.

Financial pressures will continue in 2007/08 in all areas of health and social care.  Both Devon Primary Care Trust and Devon Partnership Trust will have a clear focus on financial recovery at the same time as working with Devon County Council to further integrate the delivery of services and to establish joint strategies.  The effect of financial pressure in all areas must be recognised although there are also benefits to the process of integration in that it gives greater urgency to solving problems jointly.  The measures described in the Business Plan to introduce closer working in partnership with the health sector to deliver health and social care will be critical to the achievement of financial balance as well as improving the quality of services.

This environment requires: -

• Strong leadership at all levels of management to deliver cultural change;
• Rigorous workforce planning to ensure staff are skilled to carry out new roles and functions;
• Team/action planning to systematically implement organisational objectives;
• Improved monitoring to secure better, more cost effective services for users and carers;
• Strong alignment between staff appraisals, personal development plans and organisational needs.