Transcript Health and Social Care

Prevention, Partnerships and Resources
Professor John Bolton Consultant
JRFB Ltd
New Model of Social Care
Based on three principles:
Prevention
Partnerships
Promoting Independence
Focus on interventions that produce outcomes
that promote independence -
Public Bodies (Joint Working)
(Scotland) Bill – Policy Memorandum
Aim to integrate health and social care to
improve consistency of approach so that
people get the quality of care they need to
remain (where possible) in their own homes.
To meet the needs of increasing numbers of
people with longer-term and complex needs.
Focus on delayed transfers of care
“ Too often older people are admitted to
institutional care when an package ….. might
have maintained their independence better”
Challenges for Social Care
Can we manage demand at a
time of increasing demographic
pressures?
Yes we can..............................
Different levels of Prevention
(Source Institute of Public Care)
Universal provision (the preventative aspects of universally available
services)
Preventative provision for populations that contain some elements of
vulnerability (specialist services that may tackle some aspects of need
but not ones which would have led to an assessed social care
intervention or an acute episode of health care).
Targeted restorative interventions (interventions targeted on very
particular populations in the evidence based belief that if successful
they will lessen potential future demand for high intensity care).
Deferred interventions (interventions that are preventative in that they
defer people for a time from a poorer outcome).
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The front end of the Services…
Universal Interventions
All Services that
address issues that
assist people in being
diverted away from any
direct help from health/
social care.
Personal
responsibility for our
own health
Includes
neighbourhood and
community teams –
Public Health – “Every
contact counts”
Voluntary Sector –
enabling people to help
themselves
Information and advice
Targeted services at those
deemed “at risk”
Services where an
intervention would expect
to lead to an improved
outcome that should need
no further help
Former Supporting people
services/
Community Alarms
Risk stratification models
with health – virtual wards
Telehealth – risk
management
Tackling social isolation
through community
networks
Getting the right equipment
Carers Centres/Vol Sector
Getting the right housing
The front end of the Directorate …
Services that support
Recovery,
Rehabilitation,
Reablement,
Recuperation
Out of Hospital Care Intermediate Care
(Community and
Residential)
Training for
employment
Sensory impaired
services
Crisis Resolution
Teams
Promoting
Independence Teams
Interventions that defer
the need for more
intensive care
Expert Patient –
managing your condition
Managing dementia after
diagnosis – learning to
live with a condition
Supporting Carers
Telecare products that
are aids to daily living –
monitoring and alarms
Supported Housing and
Extra-Care Housing
•Assessments
Assessments
for
forlonger
longerterm
care
term–care –
personal
personal
budgets/
budgets/
choice
choiceand
and
control
control
Interventions NOT Assessments
At every stage of the care pathway – we have
two aims –
to intervene in a way that will reduce longer
term needs and
to intervene in a way that maximises
someone chance of being independent
Never assess anyone for longer term care
solutions when they are in a crisis
We do need to still recognise when people
need good quality care e.g. Palliative Care
WE HAVE TO MAKE THE BEST
THING TO DO THE EASIEST
THING TO DO
Is it easier to call an ambulance or admit
through A and E than assist someone into a
step-up bed?
Is it easier to admit from hospital to residential
care than to make alternative provision –
especially in the community?
The critical partnership with
Health
Priorities for Health - You don’t suffer from the
same things that make you die
Dementia – Incontinence – Falls – Stroke
Recovery
vs Cancers and Heart Failure.
Under the legislation (The Community Care Act 1990) the Council has a statutory responsibility to assess a person’s needs and identify how these
How will integration with health help?
Getting the interventions right at the right time
(Dementia Care)
Dementia Care
Preventive actions
Assistive Technology
Maximising social capital
Positive risk taking
Listening to cares and users views
Dementia cafes
Dementia Advisors
Dementia Support Workers
Dementia awareness Training
Supporting care homes
Dementia Friendly communities
Personal Assistants – Dementia
Living with Dementia Programmes
Every Contact Counts - prevention
Early Diagnosis – GP awareness
Assistive Technology
Positive risk taking
Listening to cares and users views
Memory Assessment
Reducing use of antipsychotics
Dementia Trained workforce in
hospitals
Supporting nursing homes
Primary Care Co-ordinators
End of Life Care
Living with Dementia Programmes
How will integration with health help?
Shared understanding of desired outcomes
(keeping people out of hospital / residential care)
Getting the interventions right at the right time
(Dementia Care) – understanding and accepting
where investments might be required (Care Coordinators/ District Nurses)
Getting the care pathway right
Consistency in approach (Virtual Ward)
Some warnings!
A little bit of care may be bad for
you!
Don't make a lasting decision in a
crisis
Dignity and Control – don't take
these away
Right result – wrong outcome (see
below)
Case example from Vale of
Glamorgan
Health Board urged the local authority to help
them in speeding-up hospital discharges
But the outcome was more cost
to both health and social care
Steady reduction in numbers of older
people in residential care in England
Reduced use of residential care in
Wales
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The rate of older people in Wales(aged 65 or over) whom the authority
supports in care homes per 1,000 population aged 65 or over at 31
March
30
Axis Title
25
20
15
10
5
0
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
2009-10
And in Scotland after blip….
Older People in Residential Care in Scotland
March 2000 - March 2011
39,500
39,000
38,500
38,000
Older People
37,500
37,000
36,500
March
2000
March
2001
March
2002
March
2003
March
2004
March
2005r
March
2006
March
2007r
March
2008r
March
2009r
March
2010
March
2011
Avoiding unnecessary admissions
Always make sure that you have given time for a person to recover from
the crisis that led to the assessment for possible residential care.
Don’t assess a person for residential care from a hospital bed.
Make sure that older people are receiving the best possible health care in
both hospital and in the community (to avoid admission).
Ensure that dementia is diagnosed and supported at the earliest
opportunity.
Ensure that Intermediate Care is delivering its intended outcomes (with
Health).
Consider housing based alternatives and the use of assisted technologies
to reduce the levels of risk.
Ensure that workers are taking proper time to assess and consider
alternatives before agreeing to a placement.
The Resources
Getting the care pathway for prevention right
can lead in a 3 year period to:
33% reduction in admissions to residential care
10% reduction in people who need intensive
home care
50% reduction in people who need low level
home care
Constructing the new system (1)
The Council will seek to ensure that its interventions in people’s
lives are timely and effective. We will offer a short-term piece of
help where we can ensure that this will help someone back into
living independently. We will look to divert someone away from
formal care by helping them access community based resources
where this may offer effective help. Our focus is on recovery,
recuperation, rehabilitation and re-ablement.
The Council will look to offer joint services with the local health
services where this is appropriate.
The Councils aims to ensure that it offers value for money in all the
services it has on offer. Any internal provision will be cost
effective and be lean in its management and administrative
costs.
We will offer support to carers where this will help someone to live
in the community.
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Constructing the new system (2)
We will develop housing options that enable people who have care
needs to live independently in the community.
We will use new technologies to ensure that we can respond to
people’s care needs in a timely and effective way.
The Council will work with the Voluntary Sector to help them develop
the capacity to offer more voluntary work and to ensure that they
are adding value with their contribution to social care.
The council will target most of its resources on those people with the
highest and most complex care needs.
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For more help……….
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John Bolton
Independent Consultant
07789748166
[email protected]