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Buckinghamshire CC governs one of the most affluent counties in the UK, but is not immune to financial pressures, particularly in the area of adult social care, as Rita Lally explains. Like many local authorities, Buckinghamshire CC has an ageing population which is set to grow over coming years. We currently have 77,600 people aged over 65, and this will increase over the next 30 years to more than 100,000. We are financially strapped, with one of the lowest council taxes – Band D – of any South East county. We are also a ‘floor authority', and Audit Commission data shows that adult social care spend on older people is lower than most of our comparative local authorities. Despite this, we have been able to achieve a four-star status in the last CPA, and while not smug, we are pleased. So, the situation is this – not only do we have little money to throw at this, we also know that public expenditure in coming years will be cut, so we must use the resources we have got wisely. We also need to continue to harness and build community resources and resilience. We ask people who can be independent and make a contribution, to do so, as we recognise that rights and responsibilities have to be balanced. On the plus side, we are one of the healthiest and most affluent populations in the country, and residents report very high levels of satisfaction about life in Buckinghamshire. While we fully understand the pressures an ageing population brings to bear on health and social care, we also have a philosophy that most older people actually contribute to their communities by volunteering and often supporting their children with child care and other support. We believe we must build community capacity to enable older people to be supported in their communities for as long as possible, but also to contribute to their communities for as long as possible. For example, many of our home care staff are aged in their sixties and they provide services to many older people who are 85-plus. Some of our councillors – parish, district and county – are aged over 65, and make a huge contribution to their communities and electorates. So, we need to change our mindset that an ageing population equals a drain on resource. It does not. This mindset and philosophy led us to develop a strategic framework entitled ‘because Every Adult Matters' (bEAM), which is how we will continue to develop and modernise public services. The underpinning philosophy of bEAM is that every adult in Buckinghamshire can make a contribution to their community by volunteering and being community builders, and that every adult is also entitled to advice from the council. For those in the greatest need, they will be entitled to a range of services to meet their needs, in their own homes and communities for as long as is possible. Buckinghamshire has a comprehensive strategy around place-shaping and locality working, and we call it ‘Getting closer to communities' (GC2C). Adult social care plays a key role in this and balances the philosophy of fair access to services for all, but tailored to meet different local community and individual need. We are piloting an ambitious programme with districts, parishes and the voluntary sector around building community capacity so that vulnerable and particularly elderly people, can be supported to live in their communities for as long as possible. The pilot areas involve an urban area (Chesham) and a rural area (Haddenham), so that the different dimensions of urban and rural needs are understood and appropriate efforts then marshalled. The project is funded by the South East Improvement and Efficiency Partnership. Like many local authorities, Buckinghamshire has many ‘self-funders', who do not always get the best advice and are tending to admit themselves prematurely into long-term care. The homes chosen by self-funders are often expensive, which presents difficulties when the individual's money runs out. Self-funders who have run out of money represent 12% of those funded by the county council in long-term care, and last year the costs were about £2m. In order to provide advice and support and help, all Buckinghamshire residents make informed choices. We launched the ‘InTouch' service two years ago. It is a key component of bEAM, providing a telephone assessment, advice, information, signposting and review service to people who do not meet the eligibility criteria for statutory services but are at a potentially vulnerable stage in their lives. It offers help and advice about planning care needs and local services and activities via an initial contact and further calls, four times a year. The service has already provided advice and support to thousands of older people, and has been very well received, with comments such as, ‘Because of the referral you made to occupational therapy on my behalf, I have been able to have a shower fitted in my home to enable me to be independent. Thank you for your concern, and willingness to help me', and a typical comment from many of our older people is, ‘I really do appreciate you keeping in touch with me. The service you are providing is invaluable. Thank you so much'. Research undertaken by the Institute of Public Care (IPC) at Oxford Brookes University found that the reassurance and regular contact which the service provides was contributing to the ability for older people to remain independent. The InTouch service will continue to be developed to respond to a changing environment, not least of which is the current severe recession which will adversely impact on people in Buckinghamshire who may previously have made their own arrangements for care and support. The service is not expensive, costing £200,000 to run, and it supports about 5,000 people, making it a genuinely cost-effective service. So what of the future? I think the irony of the potential public sector cuts we will be facing in future years will drive the public sector to combine resources and services in a way that simply has not been done before. Can we really justify cuts to frontline services if, in fact, we can make efficiencies by doing things differently and together? In Buckinghamshire, we are mapping our day services, health day, library provision and others, to explore what we can do differently to provide good services, but at a much lower cost. Would older people choose to go to a day centre if they could go to a welcoming library which offered good community support networks? Probably not. The added driver in our quest of optimum and nimble use of resources, is that with self-directed support on its way, we simply cannot afford to run two models of care, for instance, give clients money to buy support services but still run a half-empty day service. This means in Buckinghamshire, the development of self-directed support in is being tightly linked to a transformational efficiency agenda, and we have already got a number of policy directions from our cabinet which supports a radical new way of working. In summary, while it is obvious there are very real challenges ahead, Buckinghamshire views these challenges as opportunities to do things differently. Rita Lally is strategic director, adults and family wellbeing, at Buckinghamshire CC

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Because every adult is worth it

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