Transcript Document

Practical Delivery
of the
Accommodation
Strategy
KHG OP Day 22 October 2014
Christy Holden – Head of Commissioning
(Accommodation) Kent County Council
Why we need an Accommodation Strategy
• KCC spends £180m on residential and nursing care
• The right type of accommodation in the right place
• Stimulate the market or directly intervene
• Inform planning applications
• Secure better outcomes and make savings
• Quality and safeguarding
Development of the Strategy
• Joint KCC, NHS and KHG document supported by
KPOG and the DH Housing LIN
• Analysis of KCC case load, placement patterns,
availability of services
• Engaged with local teams, CCG’s, District Councils in
its development
• Formal approval and launch in July 2014
The Accommodation Strategy
www.kent.gov.uk
About the Council
Strategies and Policies
Adult Social Care Policies
Accommodation Strategy
www.kent.gov.uk/accommodationstrategy
Accommodation Strategy Overview
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•
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•
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Dynamic strategy
On-line with links
Evidence Base
Case studies
Maps
Design Principles
District Profiles
Key findings by user
group
• Financial Impact
• District aligned with
CCG Consideration
Accommodation for Older People Analysis
Service Type
National Ratio
Kent Ratio
Sheltered
125 units per
1000 pop 75+
144
Extra Care
45 units per
1000 pop 75+
1.51
Residential Care
65 units per
1000 pop 75+
65.7
Nursing Care
45 units per
1000 pop 75+
30
Intermediate Care
26.3 units per
100,000 pop
29.7
Future need?
• National Ratios
• Population forecast
• Impact of enhanced
community provision
• Placement patterns
• Market appraisal
• Workshops with
KCC,CCGs and Districts
Numbers are indicative and will be used to target
priority areas. Numbers will need to be periodically
reviewed and adjusted in line with the performance
of enhanced community services
District Profiles
Older People Summary
OP +/R
+43
N -111
EC +197
SH
0
OP
R
N
EC
SH
+/+5
+150
+112
0
OP
R
N
EC
SH
OP
R
N
EC
SH
+/-48
+108
+161
0
% increase by 2021:
Accommodation units = 6%
Older People 85+ = 30%
OP EXISTING 2021
R
N
EC
SH
+/-
8200 5730 -2470
3730 5661 +1931
490
3032 +2542
17950 17706 -244
30370 32129 +1759
+/-96
+90
+114
0
Known
70
170
946
0
1186
KCC fund:
37% of placements
OP
R
N
EC
SH
OP +/R -128
N +18
EC +166
SH 0
+/-133
+52
+120
0
OP
R
N
EC
SH
+/-281
+254
+230
-87
Shift to Extra Care Housing
could reduce KCC revenue
costs by £6m by 2021
More Nursing Care
OP
R
N
EC
SH
+/-94
+270
+416
-36
Fit for Purpose Modern Accommodation
R = Residential incl. Dementia
N – Nursing incl. Dementia
EC = Extra Care
SH = Sheltered Housing
Vacancy Rate:
National = 7%
Kent = 3%
OP
R
N
EC
SH
+/-439
+264
+183
-96
Positive impact
on Kent Economy
OP +/R -360
N +195
EC +234
SH 0
OP
R
N
EC
SH
+/-621
+344
+278
0
OP
R
N
EC
SH
+/-318
+297
+331
-25
334 care homes
Average Size:
New build = 57 beds
Kent = 35 beds
West Kent = 40 beds
East Kent = 32 beds
Opportunity Areas – Acute
Acute Demand
Opportunity to support more individuals at home
Actions:
• Data capture in place to review decision making
process in acute hospitals
• Development of menu of service in one hospital
• Data capture in place to review performance of STB
outcomes
• Review assessment process for STB assessments
• Plan for roll out across all hospitals
£4.1M - £7.6M through improved short term
pathways
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The number of services
users receiving long term
residential care as a
result of the short term
pathway could be
reduced by 13%
Was Residential Appropriate?
Source: BICA Study
40%
In 11% of cases residential was deemed appropriate
35%
30%
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Reserved
25%
20%
15%
10%
5%
0%
Pathway resulted
in
Incorrect
Decision
residential placement
(Unintended/Incorrect
decisions)
Pressure from
family/ friend
Meet Housing
Need
Review1
Residential was
appropriate
Review2
Risk Adverse
No clear goals
Short Term Bed Usage - Review Outcomes
Yes –61%
STB Required
No – 39%
20
18
39%
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16
14
Users
12
10
8
6
4
2
0
STB not
required
OT Home Ax. Residential
was
appropriate
MCA
Night time
Needs
Carer's Ax.
Declutter
home
Falls Ax.
Mobility
PT Ax.
Comparison of Preference for Long Term Care
40%
40%
35%
35%
30%
30%
Rehab
Home
Ideal outcome
Unsafe at Home
Reluctant Agree to STB
Enablement/ meals
Enablement
Housing
Resi
With Family (Resi)
Unsafe at Home
Increase independence
0%
(blank)
0%
MCA
5%
Supported living
5%
Unable to say
10%
Agree to STB
10%
STB
15%
None
15%
Supported living
20%
None
20%
25%
STB
25%
Residential
%age of cases
45%
Family & friends request residential or STB 77% vs 9% service user requests. What factors lead to this decision being made by the family?
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Family/Friends Preferred Outcome
45%
Home
%age of cases
User Preferred Outcome
Source: BICA Study
Comments from Friends / Family
Concerns regarding safety
Family feel he will be unsafe living
at home alone
[NAME] is at great risk if she is to
return to home
Alternatives to STB : Enablement / Increase care packages / telecare
Concerns regarding carer’s ability to cope
Family have stated that they are
struggling to support [NAME]
recently
Wife feels unable to cope any longer
at home.
Son who states that he feels he
cannot manage his fathers needs,
and that 24hr care is needed
Alternatives to STB : Carer support / respite care / carer assessments
Concerns influence outcome with no evidence of alternatives being discussed
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Family are concerned about [NAME]
discharge home and her ability to
manage at home
What Causes Lead to Residential Placement?
Source: Panel Jan-May 2014
and PSSRU
35%
25%
20%
15%
10%
5%
0%
Informal care
breakdown
Psycho-social
vulnerability
Cognitive /
behavioural needs
Falls risk
Nursing / medical
needs
Mobility needs
Unidentified
Results based on initial study 43 residential placement cases reviewed by Panel Jan-May 2014 match PSSRU study results
Informal care breakdown, psycho-social vulnerability & cognitive / behavioural needs consistently top 3 reasons given for placement
How could we work with the voluntary sector and others to prevent these causes?
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% of Sample Cases
30%
Older People Summary
OP +/R
+43
N -111
EC +197
SH
0
OP
R
N
EC
SH
+/+5
+150
+112
0
OP
R
N
EC
SH
OP
R
N
EC
SH
+/-48
+108
+161
0
Are housing providers
supported in the care needs
of their tenants?
OP EXISTING 2021
R
N
EC
SH
+/-
8200 5730 -2470
3730 5661 +1931
490
3032 +2542
17950 17706 -244
30370 32129 +1759
+/-96
+90
+114
0
Investment in
Enablement, Short
term interventions
and 24/7 home care
OP
R
N
EC
SH
OP +/R -128
N +18
EC +166
SH 0
+/-133
+52
+120
0
OP
R
N
EC
SH
+/-281
+254
+230
-87
Reduce 2470
residential beds
across the County
All tenure considered;
keep people in their own
home
Who are we
targeting for extra
care housing?
OP
R
N
EC
SH
+/-94
+270
+416
-36
Known
70
170
946
0
1186
R = Residential incl. Dementia
N – Nursing incl. Dementia
EC = Extra Care
SH = Sheltered Housing
CCG’s investing in enhanced
community provision –
varied across the County
OP
R
N
EC
SH
+/-439
+264
+183
-96
OP +/R -360
N +195
EC +234
SH 0
OP
R
N
EC
SH
+/-621
+344
+278
0
OP
R
N
EC
SH
+/-318
+297
+331
-25
334 care homes
Delivery
• Step One: Establish Priority list based on Need, Opportunity and
Stakeholder desire
• Step Two: Agree Priority list through KCC’s Transformation Board
• Step Three: Prepare Market Position Statements and publish on the
Kent Business Portal
• Step Four: Meet with providers or developers that wish to develop
services in that area, scope all opportunities
• Step Five: Undertake business cases where investment is required
• Step Six: Issue any formal procurement opportunities and develop
legal agreements where required
Timetable
• Project and Resource planning by December 2014
• Market Position Statements/Locality Focus Schedules
to be issued from October 2014
• Undertake full analysis for people with learning
disabilities, people with physical disabilities and
people with mental health needs – underway for LD,
to start in the new year for PD and MH
King Edward Court ,Herne Bay
Questions
Christy Holden, Head of Commissioning – Accommodation
[email protected] – 07920 780623