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Building sustainable social care – reducing demand and lowering costs Professor John Bolton - Consultant JRFB Ltd
Building sustainable social care – reducing demand and lowering costs
Professor John Bolton - Consultant
JRFB Ltd
Ways to save money in Adult Social Care – England and Wales
Reducing demand for services
Reducing demand for domiciliary care
Reablement
Reviews
Reducing demand for residential care
Intermediate Care and Health based solutions
Housing based solution including Extra Care Housing and solutions for Younger Adults
Telecare and Telehealth
Driving down costs
The Resource Allocation Process
Direct Payments
Lean Processes
Mobile and remote working
Electronic Care Records
IT solutions
Models of care delivery
Commissioning for better outcomes
Externalising services
Procurement
Children’s Transitions
Adult Placement Schemes
Further ways to save money in England and Wales
Raising monies
Citizens Contributions
Continuing Health Care
Diverting people away from social care
Stricter eligibility
Day Care future
Employment and Training
Customer Contact
Partnership working
Health
Shared costs
Falls prevention
Screening
Other partnerships
Better management
Reviewing staffing numbers and structures
Skills mix and Job Carving
Tackling sickness levels
Admissions to residential care from hospital
Vale of Glamorgan – improved discharges
At a cost to the PCT – increased nursing home admissions
Telecare and telehealth
Positive noises from whole system demonstrator sites
Hard to identify “savings” because intrinsic to approach to lowering demand – but business case can be made – North Yorkshire
Investments and Partnerships – Birmingham
Could be part of the joint solution with NHS
Derek Law. MBEDerek Law. MBECorporate Director, Corporate Director,
North Yorkshire County CouncilNorth Yorkshire County Council
Telecare – Part of our Care Market Solution
Our Basic Budget Strategy.
Reablement
Extra Care
We have over 12,000 using lifelines, 3346 have had access to telecare and each team
has a monthly target to increase usage.Cumulative total of Telecare Services Started April 10 - February 2011
(new people who did not have a Telecare service prior to 010410)
0
50
100
150
200
250
300
HC Started
HR Started
Selby Started
SWR Started
Average
Target
HC Started 13 23 31 54 73 97 126 173 190 203 220
HR Started 14 35 65 96 113 129 146 188 211 230 239
Selby Started 9 18 25 38 60 73 86 104 119 133 142
SWR Started 17 30 47 64 76 89 111 140 157 164 175
Average 13.25 26.5 42 63 80.5 97 117.25 151.25 169.25 182.5 194
Target 16.67 33.34 50.01 66.68 83.35 100.02 116.69 133.36 150.03 166.7 183.37
April May June July August September October November December January February
We set ourselves a 10% increase at the beginning of the year. We are achieving on average a 14% increase !
Outcomes and achievements
• Between April 09 – Now – some 5000 multi-agency attendees at awareness, PR and installation training
sessions. – The approach is assisting staff to manage risks when providing customised
services. – People speak of how the service has helped them to carry on living at home
give more confidence/peace of mind, feel safer. – All staff in social care have received awareness training, with new staff
targeted soon after arrival. It is embedded as part of our reablement It is embedded as part of our reablement programme.programme.
– The County has created a training pack and guidelines for fitting equipment and developed Long Term Conditions pathways for a range of conditions with PCT.
– LD providers now beginning to embed personalised technology as part of support.
– Short stay residents to EPH’s offered Telecare to use in EPH and take home.– Telecare tested and piloted in home for people with dementia and
demonstrated improved outcomes for residents and staff. ( St Celia’s)
The Finance Case• We have an ongoing process of evaluation:
– Care managers identify what people’s traditional care package would have been if Telecare had not available, and what the actual Telecare enhanced packages of care were.
– 46% traditional packages would have been residential, EMI or nursing. – 54% traditional packages would have been care at home. – If existing homecare is >10 hrs, the trends indicated homecare reduced,
but still an element of care. – If the traditional package was <7 hours, the trend was home care hrs
reduced or not have to be provided at all. – Analysis indicated a net average efficiency/person on annual basis at
£3,654 – – a 38% reduction in care package costs.
• The DH and CSED have now taken NYCC model and expanded it as a national evaluation tool. See the SCED website.
Case Studies
• Numerous!• Tell the story ..we have numerous case
studies … they capture minds and hearts.• How people are in control• Personalisation.• This is both a finance story and more
importantly one of people being more in control of their own lives.
Thank You
A Range of videos, case studies, reports and other resources are freely
available at: http://www.northyorks.gov.uk/telecare
Derek Law MBE Corporate Director
Making Telecare Happen Fast!!
Linda Sanders
Director of Social Care, Health & Housing
London Borough of Hillingdon
Change of scene
• Previously Director in Dudley– Developed an effective Telecare service in the Borough over a number
of years
– Recently accelerated this development with Tunstall’s assistance
• Moved to new job in Hillingdon– Telecare under-developed
– “Marginal” service
– OPPORTUNITY!!! Better outcomes, save money!!!
Making it Happen
• Plan has 4 key elements:-– Business Case– Leadership approach– Ensuring local services are “Fit for purpose”– “Winning over” the front line staff
Making it Happen
• Business Plan– Developed by Finance team
– Foresees a net £4m+ saving over 4 years, (£805k first year)
– Need to save 80 residential care weeks to breakeven, (year 1)
– Delivers 3,000 Telecare users
• Leadership– Council and SMT on board
– Clear, strong message about the vision
– Appropriate Performance Management put in
– “Partner Plan” put in place to ensure third sector, independent sector and citizen voice organisations are also on board
Making it Happen
• Local services “fit for purpose”?– Good basis in place with existing service
– Made sure that capacity to meet demand was properly planned
• “Winning over the Front Line”– Training, training, training!!!
– Win over “hearts and minds”, NOT about the technology
– A little bit of “stick”!!• Team targets for referrals• You need a reason WHY NOT to include Telecare
Making it Happen
• A couple of other key things:-– Assigned clear delivery responsibility to Assistant Director in order to
ensure that the work is done
– Hired a project manager to drive implementation, (part time)
– Work closely with the Telecare supplier
Thank you very much for listening!!
