North West Region Housing LIN Meeting Extra Care: A Local Authority Perspective and Strategy Jenny Holt Commissioning and Service Development Manager Ray Deakin Market Relationship Officer

Context Adult Social Care Commissioning completed a review of the residential care market in Trafford in 2005 This review found that the current market was traditional, stagnant and not in a good position to respond to: future needs of an ageing population with complex long term conditions increasing customer and carer expectations CQC regulatory standards

Context As a result of the review, an Accommodation and Support Strategy was developed in partnership with a range of key stakeholders including housing, health and the voluntary and community sector The strategy has facilitated a huge shift in the market as a whole The Council have evidenced this shift through: the reduction of council owned residential care homes the development of two Extra Care Facilities in borough the mainstreaming of accommodation and support in local communities, facilitated by personal budgets

Current Position Trafford Council have responded to changing demographics by collaboratively developing two Extra Care schemes in the last six years Trafford Council recognise that Extra Care provides the independence of self contained accommodation with the option of on site support, offering security and consistency regardless of support needs and changes in care requirements

Current Position The two Extra Care Housing schemes within the Borough are: Elkin Court Newhaven Both of the schemes were funded jointly by the housing associations and Trafford Council, they are both purpose built.

Elkin Court Elkin Court was the first Extra Care facility in Trafford. It is based in the Partington which is in the north of the Borough. Construction began in January 2007 and June 2008 saw the first cohort of residents move in.

Elkin Court It comprises of 40 flats; 24 one bedroom apartments and 16 two bedroom apartments. These are available to rent with assured tenancies The scheme is both owned and managed by Housing 21 and on site care is commissioned by Trafford Council Creative Support who underwent a competitive tender process won the contract to provide support The scheme has number of facilities on site including lounge, café, laundry, guest facilities, garden, community centre, activities room, cafe, shop, hairdressing salon and an assisted bathing facility. Access to these facilities is open to both tenants of the scheme and the wider community.

Newhaven Newhaven Extra Care Facility was the second facility of its kind in Trafford; it is based in the Timperley area in the south of the Borough. Construction began late September 2009 with a grand opening in taking place in March 2011.

Newhaven The site has 38 flats in total compromising of 20 affordable rent properties and 18 shared ownership. The scheme is owned and managed by Trafford Housing Trust and on site care is provided by TLC who underwent a competitive tender process for the contract. Facilities at the scheme include: a restaurant, residents' lounge, a hairdressing salon, assisted bathing facilities and a wellbeing room, which can be used for activities ranging from memory clinics to aromatherapy The scheme also has two intermediate care flats commissioned by the PCT

Evaluation of Extra Care in Trafford Background: In 2012 Trafford Council conducted an evaluation of extra care in the borough. The aim of the evaluation was to ascertain what was working and what was not working within the Extra Care Schemes within Trafford, to inform improvements to both existing and future developments

Evaluation of Extra Care in Trafford Methodology: A number of methods were used to gather as much information as possible, and to ensure that all stakeholders had an equal voice. Research The initial stage of the evaluation involved investigating what great Extra Care provision looks like and how it could be evidenced within the schemes currently operating within Trafford.

Evaluation of Extra Care in Trafford Self Assessment and Verification Visits Stage two of the evaluation was to devise a self assessment questionnaire that would capture how both the Scheme Managers and Care managers are working towards delivering a great service while evidencing positive outcomes for their service users. The self assessment tool captured details on the following areas: Staffing levels Training Allocations Dependency Levels Hospital Admissions, Cost Effectiveness Personalisation. Each submitted self assessment was followed up by a verification visit.

Evaluation of Extra Care in Trafford Evaluation Packs Two evaluation packs were compiled, one for local residents and another for tenants of the scheme. Each pack contained: A questionnaire (specific to Local Residents or Tenants) Contact details of the council for feedback An invitation to a drop in session The local resident questionnaire focused on involvement in the development of the scheme and usage of the facilities on offer. The tenant questionnaire focused on individual experiences now and before moving into the scheme

Evaluation of Extra Care in Trafford Drop in Sessions Drop in sessions were conducted at both of the schemes for both local residents and tenants to attend. These sessions were facilitate by Trafford Quality Checkers, a bank of volunteers who offer support to projects in an impartial capacity. Trafford Quality Checkers allowed for an open discussion between local residents, tenants and their families around personal thoughts and experiences of the schemes.

Evaluation of Extra Care in Trafford Other stakeholders were involved throughout the evaluation, to fully inform the review, these included: Trafford's personal budget teams Trafford's Finance teams Other local Authorities Trafford PCT Trafford Link Third Party Providers i.e. Age UK Trafford

Evaluation of Extra Care in Trafford Findings Positive Outcomes The two extra care schemes are delivering positive outcomes for the individuals who live within them the evaluation evidenced this through feedback from individuals who felt that they were achieving positive outcomes including better quality of health, increased quality of life, increased social inclusion and better perceptions of safety and security. Tenants of the scheme are living more fulfilled lives within a community of which they feel valued. Reduction of Hospital Admissions The evaluation evidenced that Extra Care, compared to Residential Care, Sheltered Accommodation and Homecare has the fewest hospital admissions. It was also noted as part of the evaluation that people in Extra Care have a shorter stay in hospital.

Evaluation of Extra Care in Trafford Findings Cost Effectiveness The evaluation looked at the average cost of care between a Residential placement and a placement in Extra Care, this comparison took account of Housing Benefit, Council Tax Benefit and a unit share of both block and spot contracts in Extra Care against the set price of a Residential placement. The evaluation found that, compared to the average Residential Care cost of £389.75 per week, the average cost of Extra Care was £142.70 per week cheaper.

Evaluation of Extra Care in Trafford Areas of Improvement The evaluation uncovered some key learning points in relation to improving existing provision; these are focussed on the following areas: Partnership Working Improved partnership working between Care Manager and Housing Manager is essential to delivering a joined up service and achieving positive outcomes. Third Party Links Scheme managers need to establish better third party links to achieve greater inclusion and access to services for schemes, including health services, for tenants

Evaluation of Extra Care in Trafford Areas of Improvement Personal Budgets Awareness of personal budgets and their benefits could be increased amongst tenants. Dementia and Learning Disability Awareness There were gaps regarding staff training in dementia awareness and in Learning Disabilities awareness Assessment and Reablement Assessment and Reablement could improve their response to alterations of individual care packages Greater Independence Further work is needed for tenants to achieve greater independence and better health

Evaluation of Extra Care in Trafford Areas of Improvement Allocation Information Better information is needed at point of allocation to maintain a balanced community Community Profile Work needs to be done with the surrounding community to raise a positive profile of Extra Care within the respective area Support Needs Awareness People living in the scheme were not aware of the support needs that some people may have or the individuals who may want to access Extra Care, work needs to be done to raise awareness in this area Intermediate Care There needs to be greater awareness of the intermediate care beds available

Evaluation of Extra Care in Trafford Recommendations Accommodation and Support Provider Recommendations Information sharing: A robust mechanism to share information should be developed by the Accommodation Provider and Support Provider, in partnership with Commissioning, and should be implemented to ensure there is a collaborative approach to providing Extra Care Service Delivery: the accommodation and support functions are provided by two separate organisations there should be a management agreement in place which clearly stipulates each providers responsibilities and details areas for cross organisation working.

Evaluation of Extra Care in Trafford Recommendations Use of Core Contract: To review the use of core hours. It is essential that the core contracted hours are used as efficiently as possible in order for tenants and Trafford Council to get the best value service possible Profile Raising and Networking: Both the Housing Manager and Care Manager at Elkin Court should be taking a proactive approach to ensure that links with private and voluntary sector providers are established and maintained, Allowing further access to services for the tenants. The accommodation manager at Newhaven should facilitate relationships with the schemes immediate neighbours to raise the profile and encourage involvement.

Evaluation of Extra Care in Trafford Recommendations Increasing Independence: A collaborative approach and understanding of how each service aims to achieve independence outcomes for individuals would maximise achievement A tool should be created collaboratively between Housing and Care providers that collates evidence to support the achievement of positive outcomes. Allocation Process In order to engineer a balanced community of individuals who have differing levels of support requirements, the allocation process should take account the assessed needs of individuals in conjunction with the form of tenure they will access; part ownership or rented.

Evaluation of Extra Care in Trafford Recommendations Trafford Council Recommendations: Learning opportunities Trafford Council to nominate an officer to become a member of the North West Extra Care professionals meeting Assessment Professionals submitting assessments and referrals for tenancy in Extra Care must ensure that all information is up to date and relevant. Quality Assurance Market Relationship Officer Team to review the scheme as a whole and not just the care provision on site through the Trafford Quality Market Management Tool

Evaluation of Extra Care in Trafford Recommendations Future Development Recommendations: Building Issues A number of key findings relating to the build of Newhaven have been highlighted as part of the review, specifically Telecare black-spots in the building, the difficulties in controlling the under-floor heating and the issues with the guttering and roof. These learning points should be reflected on to ensure that similar problems do not present in future developments. Understanding Extra Care In future developments potential tenants need to be made aware of the scope of care and support needs that will be accommodated within the scheme.

Evaluation of Extra Care in Trafford Recommendations Alternative Models Further investigation should be completed looking at the pros and cons of the different ways of commissioning care in future developments, including Individual Service Funds, pooled personal budgets and personal budget only models, placing the commissioning of services in the hands of the tenants of the scheme.

Evaluation of Extra Care in Trafford Recommendations Staff Development Staff Training: All staff working in the schemes should undertake in depth dementia training to enable the tenants with a diagnosed dementia to be supported more efficiently. All Tenants should be given the opportunity to attend a brief dementia awareness training session to gain a better understanding of dementia. All staff working in the schemes should undertake Learning Disability Awareness training to enable the tenants with a learning disability to be supported more efficiently. All Tenants should be given the opportunity to attend a brief learning disability awareness training session to gain a better understanding of learning disability

Evaluation of Extra Care in Trafford Recommendations Personalisation Personal Budgets: Trafford Council to ensure that the tenants of the schemes are aware of personal budgets and the benefits that they afford individuals. There should be procedures in place to promote personal budget use at regular intervals as individual care and support needs change, potentially looking at an information stand at the scheme on a regular basis. Intermediate Care Intermediate Care Beds: Trafford Council to raise awareness of operational staff of the Intermediate Care Bed provision available at Newhaven to minimise the risk of them being decommissioned by the PCT

Evaluation of Extra Care in Trafford Recommendations Financial Modelling Cost Effectiveness: Tenants in Extra Care schemes whom have the maximum care and support package available to them (i.e. 4 double visits, 7 times a week) currently cost more than the average placement in a residential home. The financial model of Extra Care should be investigated further following the Fair Price for Care Review of Trafford’s Residential and Nursing Homes in order to understand the true comparison of cost.

Evaluation of Extra Care in Trafford What Next? An action plan has been devised encompassing all of the recommendations made within the Extra Care Evaluation, to be initiated in the near future. The actions within will improve the existing service delivery at both schemes as well as inform future developments.

Future Developments Trafford Council and Trafford Housing Trust are working collaboratively developing the Boroughs third Extra Care Facility. The development will offer 71 apartments comprising of both 1 and 2 bedrooms in addition to a mixed tenure of affordable rent and shared ownership properties. The scheme is set to open its doors in March 2014. Trafford, with partners are also exploring the feasibility of a fourth extra care facility in the north of the borough.

Future Developments Trafford Council is committed to supporting and protecting older people Trafford’s trailblazing work around personalising individual support has received national recognition. This work is helping more people to remain living independently, and is key to improving their health and wellbeing. The Council has been, and will remain committed to, working with its partners to make the vision for apartment living, within a safe, secure environment a reality. Trafford's residents are benefiting from beautiful homes, with access to whatever level of extra support they need to help them remain independent  

Extra Care Any Questions?