David Pigott JIT Associate
RESHAPING CARE FOR OLDER PEOPLE AND CHANGE PLANS
Outer Hebrides Community Planning Partnership
Reshaping Care For Older People - Policy Goal:
To optimise the independence and wellbeing of older people at home or in a homely setting
Reshaping Care for Older People Commitments
> Double the proportion of the total health and social care budget for older people that is spent on care at home
> Build the capacity of third sector partners to help them do more to support the experience, assets and capabilities of older people
> Introduce a Change Fund of in the region of £300 million over the period 2011/12 to 2014/15
> Shift resources to unpaid carers – at least 20% of fund
Reshaping Care for Older People Commitments
> Improve quality and productivity through reducing waste and unnecessary variation re emergency bed days
> Reduce rates of emergency bed days used by those aged 75+ by a minimum of 20% by 2021 and at least 10% by 2014/15
> Ensure older people are not admitted directly to long term institutional care from an acute hospital
> All older people over 75 years will be offered a telecare package in accordance with their assessed needs
Shifting the balance….towards: Greater emphasis on preventative and anticipatory care A focus on recovery, rehabilitation and re-ablement Risk aware (not risk averse) Supporting engagement, self-worth and contributions (an
asset based approach) Good information, advice and support to enable control and
personalised care Good information, advice and support for unpaid carers Better alternatives to reduce bed days following emergency
hospital admissions Integrated care and support and strong joint commissioning
The Change Plans and Reshaping Care
£80 million 2012/2013,circa £300 million over 4 years. A Programme for Change – 10 year Delivery Plan Updated Change Plans developed in the Spring Slow spend in year 1 Partnership planning process – Health, Local Government,
third and independent sectors Development of joint commissioning strategies – to 2020
including funding and demographic projections for future years
Consolidate 2011/12 actions and build on wide range of other innovative work underway , including Dementia
From 2012/13 demonstrate at least 20% of spend dedicated to supporting carers
Bridging finance to lever improvement across the entirety of older people’s spend in health and social care
Meeting the challengesDemographic changes & finance Increased numbers requiring care & support
within a tight financial envelopeStatus Quo will not sufficeShifts to anticipatory and preventative
approachesCare based on principles of Co Production and
effective partnership
Change Fund - leverageChange Fund=1%-2%
Existing=98%-99%
Health and social care expenditure Scottish population aged 65+ (2007/08 total=£4.5bn)
Other Social Work
Care Homes
Home Care
FHS
PrescribingCommunity
Other Hospital care
Emergency admissions
£1.4bn
£0.8bn£0.4bn
£0.4bn
£0.4bn
£0.3bn
£0.6bn£0.2bn
NATIONAL RESHAPING CARE PATHWAY (11/12 – mid-year review), (11/12 – plans) & (12/13)
Preventative and Anticipatory Care (18%) (19%) (22%)
Build social networks and opportunities for
participation.
Early diagnosis of dementia.
Prevention of Falls and Fractures.
Information & Support for Self Management.
Prediction of risk of recurrent admissions.
Anticipatory Care Planning.
Suitable, and varied, housing, build support and housing support.
Proactive Care and Support at Home (24%) (26%) (25%)
Responsive and flexible home care.
Integrated Case/Care Management.
Carer Support and Respite.
Rapid access to equipment.
Timely adaptations, including housing adaptations and
Telehealthcare.
Effective Care at Times of Transition(33%) (24%) (28%)
Reablement & Rehabilitation.
Specialist clinical advice for community
teams.
NHS24, SAS and Out of Hours access ACPs.
Range of Intermediate Care alternatives to
emergency admission.
Responsive and flexible palliative care.
Medicines Management.
Access to range of housing options.
Hospital and Care Home(s)
(19%) (23%) (16%)
Urgent triage to identify frail older people.
Early assessment and rehab in the
appropriate specialist unit.
Prevention and treatment of delirium.
Effective and timely discharge home or
transfer to intermediate care.
Medicine reconciliation and reviews.
Specialist clinical support for care
homes.
Enablers (6%) (7%) (8%)
Outcomes-focussed assessment
Co-production
Technology/eHealth/Data Sharing
Workforce Development/Skill Mix/Integrated Working
OD and Improvement Support
Information and Evaluation
Commissioning and Integrated Resource Framework
measuring shifts in balance of Care from institutions to home
Partnerships need to know impact of actions Assurance also required for Ministerial Strategic
Group Nationally available Outcome measures and
indicators available for use Local Improvement measures where required Partnership Resource Use – Integrated
Resource Framework Community Care Outcomes Framework Sustainability – Life after Change Fund Monitoring along the reshaping care pathway
Prevention and Early Identification
Learning from other programmes – e.g Dementia and associated demonstrator projects and research; Long Term Conditions; Carer Strategy
Housing Strategy Community Capacity , Co-production &
information investment Social Networks Prevention of falls Prediction of risk – SPARRA – Primary Care Anticipatory Care Planning
Core Improvement Measures
National Outcome measures and indicators Emergency admission bed day rates over 75s; delayed discharges data ; prevalence rates for diagnosis of dementia; % 65+ who live in housing rather than care home/hospital% time in last 6 months of life spent at home or in community setting; user and carer experiences
Local Improvement MeasuresAnticipatory and preventative Proportion of over 75s at home with anticipatory care plan shared with out of hours staff; Waiting time between request for adaptation, assessment of need and delivery ; Proportion of over 75s with telecare; reduction in support required after reablement ; respite care per 1000 pop ; Acute demand and effective flow in Acute Care rates of 65+ to A&E after fall; proportion frail emergency admissions access to geriatric assessment within 24 hrs ; Long Term Residential Care level of admission of new entrants from home; hospital; after intermediate care ; graduate from emergency respite
Partnership Resource Use
Integrated Resource Framework data will be particularly useful
Per Capita weighted cost of accumulated bed days lost to delayed discharge
Cost of emergency bed days for over 75s per 1000 population
A measure of balance of care split between spend on institutional and community based care
Supporting Learning and Improvement Improvement Network established Regular network newsletters / Website Learning events and Web Ex sessions Gathering intelligence and disseminating examples of
initiatives Specific development activities / events e.g. Joint
Commissioning Strategies Involvement in development work on performance
framework JIT link people to each partnership
Community capacity and Co-production support Carers Issues support
Other Areas of Direct Impact on Change Plans potential further integration of health and
Social Care subject to legislation closer working between statutory
partners to deliver better outcomes for all adults, bringing together health and social care resources, financial and operational
Self Directed support Bill – partnerships to ensure SDS central to service options developed under change fund