Transcript The role of residential and nursing care homes

The Torbay Model
– meeting people’s needs
and expectations
Dr Carol Tozer
People Commissioner
Looking at tomorrow and over the
horizon
• Number of people aged over 85 will
double by 2026 to about 2 million: number
of people over 100 will have quadrupled
• Currently – about 4 people under 65 for
every person; by 2029 this will be 3 people
• Healthy life expectancy is falling behind
life expectancy – people are spending
longer time living with conditions that
seriously affect their quality of life (effects
of stroke; diabetes; dementia etc)
And in Torbay…..
• 1990 – 36,800 people aged over 60
• 1990 – 3,700 people over 85
• 2010 – 42,500 people aged over 60
• 2010 – 5,400 people aged over 85
• 2030 – 61,200 people aged over 60
• 2030 – 10,100 people aged over 85
Evidence that people’s needs are
being met: CSCI 2008 reported:
• 25% people seeking help fell outside
Councils’ eligibility criteria
• Of those not receiving help: 35% people
said they managed without; 32% got help
from family members; 23% made private
arrangements; 10% were helped by a
voluntary organisation
• 1:5 people identified themselves as carers
– and 1:8 of those who could benefit were
not offered an assessment of their needs
Much is changing
• The white paper (finally) published 30 March 2010
establishing proposal for National Care Service
• Further evidence of worsening pressures on the social
care system – tighter eligibility criteria
• Growing impact of recession on needs and resources –
soaring levels of public debt, inevitably affecting views
about affordability and sustainability
• Putting People First – signalling new delivery model
based on personalisation
• New policy initiatives in relation to dementia, carers and
learning disability
• Forthcoming election
Carers at the Heart of 21st century
Families and Communities
• Cross cutting government strategy sets
out actions for next 10 years covering
breaks, income, information and advice,
the workplace, training for the workforce,
access to employment, emotional support,
the health of carers and the specific needs
of young carers (DH 2008)
Valuing People Now
• 3 year cross cutting strategy for people
with learning disabilities – stressing
independence, rights and choice.
• Predicts that numbers of people using
services is due to increase by more than
50% to 223,000 by 2018
Living well with dementia: a
national dementia strategy
• Recognises that people with dementia will
double over next 30 years to 1.4 million
and that costs will treble to more than £90
billions per annum (DH 2009)
• Early identification, development of
specialist skills and new models of service
delivery at the heart of the strategy
The white paper sets out
• Principles of: affordability; fairness;
consistency; and self determination
• Proposals for a National Care Service
• Free care and support for those with the
greatest needs
• BUT – creates (another) Commission to
develop the contribution and funding
proposals – and new system will not start
until after the next Comprehensive
Spending Review period
Domiciliary Care Expenditure in
the Independent Sector
Older
Learning Disabilities
Mental Health Under
65
Total
2009/10 2008/09 2007/08
6,301
5,142 3,251
1,486
1,349
918
170
103
208
7,957
6,594
4,377
Notes:
1) The above is expenditure in relation to the independent sector
areas and does not include in house expenditure
2) From 2008/09 Older People Domiciliary Care expenditure
includes Sandwell block payment (approx. £1.45m per annum)
Residential & Nursing Expenditure
in the Independent Sector
2009/10
2008/09
2007/08
Residentia
l
Nursing
Residentia
Total
l
Nursing
Total
Residentia
l
Nursing
£000s
£000s
£000s
Older
13,835
£000s
2,915 16,750
£000s
£000s
£000s
Total
£000s
£000s
13,485
3,288
16,773
11,959
3,568
15,527
Learning Disabilities
Mental Health Under
65
3,252
134
3,386
3,165
206
3,371
3,195
200
3,395
1,815
0
1,815
1,574
0
1,574
1,826
0
1,826
Preserved Rights
3,090
0
3,090
3,272
0
3,272
3,342
0
3,342
3,049 25,041
21,496
3,494
24,990
20,322
3,768
24,090
Total
21,992
Notes:
1) The above is expenditure in relation to the independent sector areas and does not include in house
expenditure
2) The above is inclusive of short
stay.
3) From 2008/09 Older People Residential expenditure includes Sandwell block payment (approx. £800k per
annum)
Snapshot of Day Care Numbers as per Client Category
2009/10 (Based on Resource Allocation Sample Work)
Independent Sector
Care Type
Day Care
Q50 Q31 - Mental Q32 Q40 - Q43 - All
Learning Q70 - Vul
Illness
Dementia Phys Dis Sensory Q44 - FTI
Dis
People
11
49
95
9
48
136
9
Total
357
In House
In House Older
Day
In House LD Day
3
Total
3
6
58
6
41
Total
14
55
153
15
% of total
2%
9%
25%
2%
6
58
6
41
5
119
126
126
5
245
89
262
14
602
15%
44%
2%
126
Total
Notes
1) This is a snapshot of client numbers for 2009/10 that is representative of the
financial year.
2) In House figures have been included due to the high proportion of market share specifically within Day
Care.
How well in Torbay
Number of in-borough homes:
117
Residential homes:
100
Residential & Nursing homes:
17
CQC Rated:
Poor –
0
Adequate –
15
Good –
73
Excellent –
27
Not Yet Rated -
2
The Torbay Model
From:
“Right care, right time, right place”
To:
“Right advice and information, right person, right
money”.
Commissioning and brokerage activities,
development of social capital and audit – placed
centre stage
The Torbay Model means
• The development of third sector
organisations and neighbourhood
provision is vital
• The organisational divisions between adult
social care and the NHS, housing, access
to benefits, access to employment support
must be overcome
• And providers must diversify and adapt to
the new marketplace.
Moving forward - together
• Torbay people are most likely to experience the
best outcomes if providers and commissioners
work together to establish the ingredients, recipe
and menu of transformation locally
• Together, we must maintain and develop new
local models of best practice
• Together, we must establish clear protocols and
ascertain a shared understanding of roles and
responsibilities of all those involved in end of life
care
Thank you
Dr Carol Tozer
People Commissioner