SSIA Webinar – 17th February 2011 Better Support at Lower Costs Improving efficiency and effectiveness in services for older people in Wales Professor John Bolton Consultant JRFB Ltd SSIA Webinar – 17th February 2011

Background and Context 4% efficiencies to be found for next 3 years New charging rules for community services (Ceredigion) Reducing admissions to residential care (Monmouthshire, Flintshire, Blaenau Gwent, Neath Port Talbot and Gwynedd Future Plans) Joint Strategies with Health (Cardiff and Vale of Glamorgan, Bridgend, Pembrokeshire and Torfaen with Joint Directors Posts) Development of reablement (Merthyr Tydfil, Monmouthshire, Rhonda Cynon Taf, Bridgend, Anglesey, Swansea, Neath Port Talbot) Some excellent medium term strategies (Carmarthenshire, Conwy, Denbighshire, Anglesey, Bridgend, Powys, Cardiff, Wrexham and Gwent Councils (Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen) Some excellent analysis for action (Ceredigion, Gwynedd, Carmarthenshire, Conwy, Neath Port Talbot, Merthyr Tydfil, Rhonda Cynon Taf, Powys)

Reduced use of residential care

Spend on Residential and Nursing Care

Strategic Direction Most strategies focus on continued reduction in demand for residential care Most strategies focus on use of reablement Some strategies are working joint with Health Some strategies are looking at extra care housing Some strategies are linked to medium term financial planning Some confusion over “helped to live at home” and “prevention”

Older People helped to live at home also reducing

Of those getting help – more are receiving this at home

Helping people at home does not necessarily mean lower use of residential care

The Oxford seven (The Institute for Public Care – Oxford Brookes University) How do local authorities work with health to ensure that older people are getting the right health care? The most common health reasons why an older person might need residential (intensive) care Dementia Incontinence Urinary Tract Infections/ Hydration Strokes Podiatry Dental Falls Why are these the areas where some health communities perform poorly?

Admissions to residential care from hospital

Admissions to residential care as a percentage of all discharges

Successful strategies 10% reduction in demand for domiciliary care through successful reablement with health 20% further reduction in demand for residential care through better use of intermediate care with health Needs stronger dialogue with health about services needed by older people ( dementia care, incontinence, podiatry, falls, stroke etc.) Needs greater use of assistive technology Needs better understanding of role of housing Needs greater use of Direct Payments Needs better understanding of costs to ease collaborative procurement Needs better commissioning including in-house Needs lean thinking for process design Needs system that helps keep older people out of social care

31 ways to save money Reablement/ Intermediate Care Telecare and Equipment Direct Payments (PAs) Reduce use of residential care (Citizen contributions) Housing with care models Housing advice and DFGs (Employment and Training) Work with Health Lean process Better commissioning Externalise services Mobile Working Reviews Procurement (collaborative) Skills Mix Big Society - Volunteering Screening Continuing Health Care Targeted prevention - falls Stricter eligibility Management and Team structures Customer contact Sickness absence Electronic Care Records Productivity Management Changing culture Administration/ IT solutions Personalisation – (RAS and PBs) Job carving Children's Transitions Patient self-management

Transformed Care System Universal Services Information and Advice – including self- funders Community Offer – social capacity Health Services Welfare Rights Advice Targeted Interventions Equipment and Aids to daily living and Telecare Products Intermediate Care and Re-ablement Supported Housing DFGs/ Adaptations Care and Repair Falls clinics and other Care and Support Eligibility Threshold Assessment and Care Management Choice and Control Direct payments Supply Commissioning the right range of services Macro and Micro procurement Contracts and Spot Purchasing Cost and Volume of supply 28 May, 2018 Nordic; Presentation March 17/18

The challenges in Wales Understanding the demographic challenges The impact of new charging arrangements Can health and social care work together? Housing as part of the solution? Paternalism and low level services – clarity on prevention Developing use of assistive technology Collaborative procurement Learning best from each other

A new model of social care That builds on keeping people out of social care That builds on interventions at a time of crisis That focuses on non-institutional solutions That builds on health and social care interdependence That challenges people to be responsible for managing their own care That uses the money more effectively That is evidence based BUT that does not meet the current requirements of government policy and regulation

For more help………. John Bolton SSIA Independent Consultant 07789 748166 john.bolton@jrfb.co.uk SSIA 029 2046 8685 enquiries@ssiacymru.org.uk