Transcript Practice Based Commissioning

Adult Care Update
since JSNA 2008
Changes Since Last Year
•
The increase in the overall population of Derbyshire is well publicised with
trend data on age profiles etc. available to download from within the
demography page of the Derbyshire JSNA website;
http://www.derbyshire.gov.uk/Social_health/inspection_of_services/joint_needs_assessment/default.asp
•
The latest population estimates released by ONS for 2008, show that the
population of Derbyshire aged over 65 is estimated to be 134,600 - this is
made up of 59,800 males over 65, and 74,800 females over 65
•
By 2028, the number of people aged over 65 is estimated to increase to
204,700 people overall.
Services for Older People
•
The increase in the number of people of 65 and over will inevitably lead to increased
pressure on social care services within Derbyshire
•
The “Baby Boomers” (post-second world war births), who will add to the population of
65+ from 2010, also have increased life expectancy and will live to older ages
•
With the increase in the size of the population needing care, this will inevitably
increase the burden on social care; The Department of Health green paper on the
future funding of adult social care (14 July 2009)
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102338
These changes imply that ’ future services will be provided to people who need support in
their own homes rather than by providing residential care services,’ and will result in;
• a need for more labour-intensive services to a widely spread countywide population
• logistical difficulties and issues in the provision of home based social care services
• a need for services to be more flexible to meet the needs of the user, and reliance on
carers to provide more support to people who remain in their own homes.
Figure 1: Percentage of Derbyshire Adult Care
Expenditure on Services for Older People (2007/08)
Source Dr Foster - KIGS Data
•
Derbyshire’s proportion of
expenditure on services for
older people is 9th highest
among its CIPFA “Family” of 16
authorities
•
Its rate is slightly higher than
the average for England, but
only average compared with
the East Midlands Region
•
The time-series chart shows an
increase across all authorities
between 2006/07 and 2007/08.
Figure 2: Helping Older People in Derbyshire to Live at
Home (2007/08)
Source Dr Foster - KIGS Data
•
Derbyshire is 2nd out of
16 only to Durham in the
rate of older people it
helps to stay living at
home
•
Derbyshire has
consistently performed
higher than the England
and Regional average on
this indicator for the last 6
year period.
Adult Care Initiatives
Derbyshire Adult Care is investing in a number of initiatives during 2009/10 as part of the
Older Persons’ Strategy these are:
•
To increase the range of specialist housing and related support for people with
dementia and complex needs.
•
To develop specialist services for older people with dementia and complex needs
•
To develop a co-ordinated programme of information, advice and advocacy services
across the County
•
The needs of carers will be addressed through the Carers’ Joint Commissioning
Strategy’
•
To review Intermediate Care services across the County and commission according
to need
•
To develop high quality, consistent falls prevention services across Derbyshire
Adult Care Initiatives cont.
•
To commission high quality, integrated Stroke Services in Derbyshire,
•
We will work with partners to reduce health inequalities and improve life expectancy
in specified districts
•
To maximise choice and control in terms of adult social care provision, by setting up
systems and services to ensure that all new service users accessing social care
services will receive a personal budget by 2010.
Home Care
Between 01.04.08 and 31.03.09, 11,335 people aged 65 or over (8.4%) received home
care provided either:
• directly by Adult Care domiciliary home care services;
• commissioned through an independent or private service; or
• via direct payments to clients. Of these some 4,530 are aged 85 or over (25.6% of all
people of this age).
Given the projected changes to the working age population available to provide care
services, such changes are likely to result in a significant shift to the current pattern of
provision, with the development of new forms of provision including social care
enterprises and more use of the “Telecare” assistive technology to support people to
remain independent.
Disabled People (working age)
•
There will be an additional 711 people with a “moderate” or “serious” physical
disability requiring support from Adult Care by 2015 (1.4% rise between 2008 and
2015).
•
Whilst the increased number of people with physical disabilities is not as large as the
increase in older person’s population, what is significant is the growth in young
people with complex and multiple disabilities in transition to adult life.
•
We are providing services to more people with complex, long-term/lifelong conditions
as well as people with traumatic brain injury or early-onset dementia who require
high-cost placements and intensive packages to support them in the community.
People with Learning Disabilities
•
The number of people aged 18-24 with a moderate/severe learning
disability is projected to increase from 363 in 2008 to 379 by 2015 (4.4%
increase) = high cost support packages
•
The number of people aged 18-64 with moderate/severe learning disabilities
will increase from 2,596 to 2,655 by 2015 (an increase of 59 people or just
over 1%)
•
A growth in the number of older people (i.e. aged 50 to 80 years) with
learning disabilities which will rise from 1,126 to 1,265 by 2015.
•
Increase in the number of younger people with autistic spectrum disorder
and cases requiring support where learning disability is not present
•
Family carers of people with learning disabilities are an ageing group who
need increased levels of support in order to enable them to continue to cope
with their caring responsibilities.
People with Mental Health Problems
(working age)
•
The number of people affected by mental health problems will increase by 1,240 (1%)
between 2008 and 2010 and by 2,526 (2%) between 2008 and 2015
•
By 2015 there will be over 115,000 people living in Derbyshire who are affected by a
mental health problem
•
An increase in the number of people with drug and alcohol dependency problems
•
Rates of mental ill health and people misusing drugs and alcohol will be further
exacerbated by the impact of the recession
•
Derbyshire compares poorly in comparison to its “family group” of local authorities for
‘Percentage expenditure on mental health’ (14th out of the comparison family of 16).
Improving Support for Carers
•
Improving Support for Carers is a key priority within the JSNA for 2009 and one of our
Local Area Agreement (LAA) targets.
•
To help us strengthen our performance we are changing the criteria for deciding who is
providing regular and substantial care/ support to people and therefore providing
improvements in the number of assessments and the delivery of services to carers.
The Challenge:
To improve the way we collect management information and obtain robust data in this area
(by improvements in the way data is recorded and maintained)
•
We are currently reviewing the support we provide to all carers across all the client
groups within Adult care with a view to re-commissioning services particularly to provide
improvements in respite services for all carers.
Making Care Personal:
Your Choice, Your Life Programme
The emphasis is now on;
• the individual’s dignity
• the right to choice
• control and power over the services they receive
• a focus on providing services at an early stage, to help prevent people
requiring high levels of care over a longer term.
Changes we propose will;
• enable people to have better access to information
• to have greater control over assessment
• more choice as to the services that suit them and their personal
requirements.
•
A transformation programme, headed by a programme board, has been set
up to implement the changes in Derbyshire - ‘Making Care Personal: Your
Choice, Your Life’ and it is expected to continue through to 2011.
Outcome Based commissioning
Outcome based commissioning is being introduced as part of the “Making Care Personal”
Programme which will focus on providing services that meet the needs of individuals and
will be measured by:
• effectiveness
• timeliness
• what outcome the user gave and how they felt about the way in which is was delivered.
The way in which these outcomes will be measured is under development but will include:
– Performance measures e.g. National Indicators;
– Results e.g. improved ability to undertake activities of daily living;
– Experience of users and carers e.g. survey results
Other client groups will focus on:
• Maintaining a high level of performance on helping people to live at home
• extending access to Direct Payments
• the development of person-centred planning
• reducing admissions to residential and nursing care.