Prevention & Personalisation A Health & Social Care Agenda

Jan Clark East Midlands Programme Director for Personalisation

The National Policy Agenda “…authentic partnership working with the local NHS, other statutory agencies, third and private sector providers, users and carers and the wider local community to create a new, high quality care system which is fair, accessible and responsive to the individual needs of those who use services and their carers.” Putting People First – The Concordat (2007)

“An integrated approach to health and wellbeing will require a step change in the relationship between local NHS organisations, local government, other relevant statutory services, employers, third sector and independent sector providers…to ensure synergy between vibrant primary and community care services and the ‘Putting People First’ transformation programme led by local government.” Next Stage Review, Darzi, 2008

• • • • • • • • •

Universal Services Leisure Information and advice Health & wellbeing Quality housing Transport Community Safety Employment services Education Libraries

• • • • • • • • •

Universal Services Leisure Information and advice Health & wellbeing Quality housing Transport Community Safety Employment services Education Libraries

• • • • • • • •

Social Capital Support networks Volunteering Neighbours/friends Voluntary sector services Carers Community work Faith communities Supporting People

Choice and Control

• • • • •

Self-Directed Support Personal Budgets & Personal Health Budgets User-Led Organisations Advocacy Brokerage

• • • • • •

Choice and Control Self-Directed Support Personal Budgets & Personal Health Budgets User-Led Organisations Advocacy Co-production Brokerage

• • • • • • •

Prevention & Early Intervention Falls prevention Intermediate Care & Reablement Early intervention Extra Care Telecare & assistive technology Community equipment ‘At Risk’ Case identification

Putting People First Milestones

Effective partnerships with People using services, carers and other local citizens Self-directed support and personal budgets Prevention and cost effective services Information and advice Local commissioning April 2010

That a communication has been made to the public including all current service users and to all local stakeholders about the transformation agenda and its benefits for them. That the move to personal budgets is well understood and that local service users are contributing to the development of local practice. [

By Dec 2009]

That users and carers are involved with and regularly consulted about the councils plans for transformation of adult social care. That every council has introduced personal budgets, which are being used by existing or new service users/ carers. * That every council has a clear strategy, jointly with health, for how it will shift some investment from reactive provision towards preventative and enabling/ rehabilitative interventions for 2010/11. Agreements should be in place with health to share the risks and benefits to the ‘whole system’. That every council has a strategy in place to create universal information and advice services. That councils and PCTs have commissioning strategies that address the future needs of their local population and have been subject to development with all stakeholders especially service users and carers; providers and third sector organisations in their areas. These commissioning strategies take account of the priorities identified through their JSNAs.

October 2010

That local service users understand the changes to personal budgets and that many are contributing to the development of local practice.

April 2011

That every council area has at least one user-led organisation who are directly contributing to the transformation to personal budgets.

2010) (By December

That all

new

service users / carers (with assessed need for ongoing support) are offered a personal budget. That all service users whose care plans are subject to review are offered a personal budget. ** That processes are in place to monitor across the whole system the impact of this shift in investment towards preventative and enabling services. This will enable efficiency gains to be captured and factored into joint investment planning, especially with health. That the council has put in place arrangements for universal access to information and advice. That providers and third sector organisations are clear on how they can respond to the needs of people using personal budgets. An increase in the range of service choice is evident. That councils have clear plans regarding the required balance of investment to deliver the transformation agenda. That at least 30% of eligible service users/carers have a personal budget. That there is evidence that cashable savings have been released as a result of the preventative strategies and that overall social care has delivered a minimum of 3% cashable savings. There should also be evidence that joint planning has been able to apportion costs and benefits across the ‘whole system’. That the public are informed about where they can go to get the best information and advice about their care and support needs. That stakeholders are clear on the impact that purchasing by individuals, both publicly (personal budgets) and privately funded, will have on the procurement of councils and PCTs in such a way that will guarantee the right kind of supply of services to meet local care and support needs.

Number of individuals aged 75+ with 2+ emergency admissions per 1000

120 100 80 60 40 20 0 High: 100 Average: 66 Low: 24

Occupied bed days of those aged 75+ associated with 2+ emergency admissions per 1000

4,500 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 High: 3,879 Average: 1,984 Low: 496

People choose less dependent options: this is typically more cost effective

General Population

TRANSFORMING SOCIAL CARE

“Low Level” Advice & Support Information Support At Home Institutional Care Crisis Response Re-ablement/ POPPs Transforming Community Equipment Support Related Housing & Assistive Technology Commissioning and Brokerage Models of Support Planning Acute Care

How well are Health & Social Care doing?

• In 2005, 2.5% (241,200) people over 65 in care homes, supported by their council. In 2009, this had fallen to 2.1% (208,530).

• In 2009, 148,000 people received support services that helped avoid emergency admission to hospital, compared to 80,000 five years ago.

• 157,000 people received support services that helped them return home quickly from hospital, compared to 112,000 five years ago.

• The number of people experiencing delayed discharges fell from 3,600 per week in 2003/04 to 2,200 per week in 2008/09.

• Non-residential intermediate care supported 122,000 people (40% increase since 2004) with 34,000 in residential intermediate care. 78% of people using rehabilitation and reablement continued to live at home.

Challenges

• A three-fold variation in the extent to which councils place older people into care homes.

• Up to a thirty-fold variation in the proportion of people experiencing delayed discharges.

• Variation in the development of joint preventative services that reduce emergency admissions.

• Variation in the effectiveness of intermediate care.

• 53% of GPs report receiving discharge summaries in time for them to be useful. Hospital to Community services interface.

• Continuing financial pressures.

Prevention and Personalisation: What does good look like?

• Joint falls prevention and fractures pathway • Joint comprehensive intermediate care and crisis response • Mainstreamed assistive technology • Self-directed support  Personal Budgets/Personal Health Budgets  Direct Payments  Service users/carers active in decision making • Primary care case identification of individuals at high risk • Health actively engaged locally in TASC/PPF delivery and governance arrangements

East Midlands Personalisation Website

www.dhcarenetworks.org.uk/Personalisation/Regions/EastMidlands