Transcript John Bolton, Derek Law
Building sustainable social care – reducing demand and lowering costs
Professor John Bolton Consultant JRFB Ltd
Ways to save money in Adult Social Care – England and Wales
Reducing demand for services
Reducing demand for domiciliary care Reablement Reviews Reducing demand for residential care Intermediate Care and Health based solutions Housing based solution including Extra Care Housing and solutions for Younger Adults Telecare and Telehealth
Driving down costs
The Resource Allocation Process Direct Payments Lean Processes Mobile and remote working Electronic Care Records IT solutions Models of care delivery Commissioning for better outcomes Externalising services Procurement Children’s Transitions Adult Placement Schemes
Further ways to save money in England and Wales
Raising monies
Citizens Contributions Continuing Health Care
Diverting people away from social care
Stricter eligibility Day Care future Employment and Training Customer Contact
Partnership working
Health Shared costs Falls prevention Screening Other partnerships
Better management
Reviewing staffing numbers and structures Skills mix and Job Carving Tackling sickness levels
Admissions to residential care from hospital
NHS nursing/group/residential care home Non-NHS (not local auth) Res Care Home
Episodes ending between 1/1/2009 and 31/12/2009 by Welsh Local Health Boards to Local Authority Areas
170 250 20 110 30 50 20 50 0 480 50 60 90 150 60 400 90 20 360 150 120 90 10 190 20 120 130 20 70 120 140 20 500 270 130 30 50 130 0 160 30 30
Vale of Glamorgan – improved discharges
At a cost to the PCT – increased nursing home admissions
Telecare and telehealth
Positive noises from whole system demonstrator sites Hard to identify “savings” because intrinsic to approach to lowering demand – but business case can be made – North Yorkshire Investments and Partnerships – Birmingham Could be part of the joint solution with NHS
For more help……….
Professor John Bolton Independent Consultant 07789748166 [email protected]
Derek Law. MBE Corporate Director, North Yorkshire County Council
Telecare – Part of our Care Market Solution
Our Basic Budget Strategy.
Downward pressure on Residential Care Admissions
Extra Care Increase Support More People Care Hours More early Intervention via 3 rd Sector
Increase use of Assistive Technology
We have over 12,000 using lifelines, 3346 have had access to telecare and each team has a monthly target to increase usage.
Cumulative total of Telecare Services Started April 10 - February 2011 (new people w ho did not have a Telecare service prior to 010410)
150 100 50 300 250 200 0 HC Started HR Started Selby Started SWR Started Average Target April 13 14 9 17 13.25
16.67
May 23 35 18 30 26.5
33.34
June 31 65 25 47 42 50.01
July 54 96 38 64 63 66.68
August 73 113 60 76 80.5
83.35
September 97 129 73 89 97 100.02
October 126 146 86 111 117.25
116.69
November 173 188 104 140 151.25
133.36
December 190 211 119 157 169.25
150.03
January 203 230 133 164 182.5
166.7
February 220 239 142 175 194 183.37
We set ourselves a 10% increase at the beginning of the year. We are achieving on average a 14% increase !
HC Started HR Started Selby Started SWR Started Average Target
Outcomes and achievements
• Between April 09 – Now – some 5000 multi-agency attendees at awareness, PR and installation training sessions. – The approach is assisting staff to manage risks when providing customised services. – People speak of how the service has helped them to carry on living at home give more confidence/peace of mind, feel safer. – All staff in social care have received awareness training, with new staff targeted soon after arrival.
It is embedded as part of our reablement programme.
– The County has created a training pack and guidelines for fitting equipment and developed Long Term Conditions pathways for a range of conditions with PCT. – LD providers now beginning to embed personalised technology as part of support.
– Short stay residents to EPH’s offered Telecare to use in EPH and take home.
– Telecare tested and piloted in home for people with dementia and demonstrated improved outcomes for residents and staff. ( St Celia’s)
The Finance Case
• • We have an ongoing process of evaluation: – Care managers identify what people’s traditional care package would have been if Telecare had not available, and what the actual Telecare enhanced packages of care were. – 46% traditional packages would have been residential, EMI or nursing. – 54% traditional packages would have been care at home. – If existing homecare is >10 hrs, the trends indicated homecare reduced, but still an element of care. – If the traditional package was <7 hours, the trend was home care hrs reduced or not have to be provided at all. – Analysis indicated a net average efficiency/person on annual basis at £3,654 –
– a 38% reduction in care package costs. The DH and CSED have now taken NYCC model and expanded it as a national evaluation tool. See the SCED website.
Case Studies
• Numerous!
• Tell the story ..we have numerous case studies … they capture minds and hearts.
• How people are in control • Personalisation.
• This is both a finance story and more importantly one of people being more in control of their own lives.
Thank You
A Range of videos, case studies, reports and other resources are freely available at: http://www.northyorks.gov.uk/telecare Derek Law MBE Corporate Director
Making Telecare Happen Fast!!
Linda Sanders Director of Social Care, Health & Housing London Borough of Hillingdon
Change of scene
• Previously Director in Dudley – Developed an effective Telecare service in the Borough over a number of years – Recently accelerated this development with Tunstall’s assistance • Moved to new job in Hillingdon – Telecare under-developed – “Marginal” service – OPPORTUNITY!!! Better outcomes, save money!!!
Making it Happen
• Plan has 4 key elements: – Business Case – Leadership approach – Ensuring local services are “Fit for purpose” – “Winning over” the front line staff
Making it Happen
• Business Plan – Developed by Finance team – Foresees a net £4m+ saving over 4 years, (£805k first year) – Need to save 80 residential care weeks to breakeven, (year 1) – Delivers 3,000 Telecare users • Leadership – Council and SMT on board – Clear, strong message about the vision – Appropriate Performance Management put in – “Partner Plan” put in place to ensure third sector, independent sector and citizen voice organisations are also on board
Making it Happen
• Local services “fit for purpose”?
– Good basis in place with existing service – Made sure that capacity to meet demand was properly planned • “Winning over the Front Line” – Training, training, training!!!
– Win over “hearts and minds”, NOT about the technology – A little bit of “stick”!!
• Team targets for referrals • You need a reason WHY NOT to include Telecare
Making it Happen
• A couple of other key things: – Assigned clear delivery responsibility to Assistant Director in order to ensure that the work is done – Hired a project manager to drive implementation, (part time) – Work closely with the Telecare supplier