In a period of intense change for health and social care, VAC gave providers funded by NHS Coventry and the City Council the opportunity to speak to NHS Coventry Chief Executive Stephen Jones and the Council's Director of Community Services Brian Walsh at a providers forum on 20 July. Stephen spoke about the White Paper proposals (click here for further details) to move commissioning responsibilities to GP consortia and abolish Primary Care Trusts (PCTs) such as NHS Coventry, whilst Brian spoke about personalisation and the opportunities and challenges it presents for providers. The meeting was very well-attended, with most of the main local providers of health and social care services present, and Steve Banbury, Chief Executive of Voluntary Action Coventry, chairing the discussion.

The scale of the current and future financial situation was illustrated by figures from both NHS Coventry and the City Council. NHS Coventry has to achieve £20m of savings by March 2012 as part of wider savings in the next 5 years expected to be in the region of £80m - £120m. This is set against the challenges of improving care and tackling health inequalities including the wide disparity in the age of death between different areas of the city. The major killer diseases (e.g. COPD, cancer, etc) in Coventry are expected to rise by 20% by 2020. The City Council is looking to make savings in the region of £80m in the next 3-4 years (set against a total spend of approx £240m), with savings of around 30% expected in the £83m adult social care budget. These figures will change, with the results of the Government's Comprehensive Spending Review (due to be announced on 20 October) being key.

Brian's presentation on personalisation is attached, with the starting point being the vision for personalisation, each word laden with meaning:

"We will directly support, or influence others, to enable every adult to have the opportunity to live a fulfilling life based on their individual choices and aspirations"

Given the scale of savings to be achieved, he emphasised the importance of connecting people to help and support available through friends and families, community facilities and universal services (i.e. those which are accessible to everyone without necessarily needing a prior assessment). At the same time, personalisation is fundamentally about providers and the Council giving people more choice and control, and focusing on outcomes rather than just processes. A pilot of a Resource Allocation Scheme (RAS) allocates a nominal figure to an individual based on achieving outcomes. It was noted that people often equate personalisation with Direct Payments, and whilst this will be key for some people, it will not necessarily feature for many others and is only one aspect of personalisation.

He noted that whilst the Council is committed to being flexible where it can, some of the contracting models used in future will be challenging to providers [VAC notes here that the Compact principle of sharing risk fairly has been helpful in a number of different negotiations over the last four months, leading to flexibility from both commissioners and providers and the avoidance of a ‘one size fits all' mentality]. He also encouraged providers not to miss the opportunities by fixating on the difficulties and felt that we need to share what's happening across our different organisations and sectors in order to be better able to influence the national debate, and to hold our nerve in managing expectations of what can be provided.

Stephen talked through the major points from the White Paper, such as:

• its emphasis on "no decision about me without me"
• a move away from process-based targets (e.g. waiting times) to outcomes (e.g. survival rates)
• all parts of the NHS to move to Foundation Trust status
• radical changes in commissioning, with the bulk of NHS Coventry's £550m commissioning budget going through to GP consortia for final decision-making and local authorities commissioning public health

These changes require legislation and are likely to be implemented in 2012 and 2013. The national consultation runs until October with a further White Paper then expected. Whilst PCTs are due to be abolished, GP consortia in taking the final commissioning decisions will still need organisational support. He noted that we all need to work together to manage this change and transition well, for example, how joint commissioning will work is not known yet nor how any new structures will inter-link into existing area structures.

The resulting discussion also covered carers; bureaucracy; the role of the Care Quality Commission, which will be reviewing its registration, inspection (more emphasis on self-assessment) and rating systems (narrative rather than stars for Councils); collaboration and consortium working; and support for GPs to engage with current ways of working. Gary Bye, Chair of VAC, summed up much of the discussion by noting that providers needed to be flexible, to think and act quickly, and to work on a ‘co-production' basis, accepting that cuts are coming and working together for the needs of all service users rather than just fighting for our own particular corner.

Further Council personalisation seminars will follow in September, and there was broad agreement that today's discussion through this VAC-facilitated providers forum was needed 3-4 times a year, with regular communications in-between (making use of existing communications as far as possible).