Stoke-on-Trent City Council Adult Social Care Transformation programme Community team plus Stoke-on-Trent City Council Adult Social Care Transformation programme

What if we told you that… What if we told you that… ..we think we’ve found a way to deliver excellent outcomes for more citizens, within the same (or reduced) cost envelope? Falling ‘repeat’ demand Increased efficiency/capacity – reablement resources Reduction in res/nursing placements Reduction in ‘maintenance’ care and support costs Increase in Direct payments Excellent outcomes for citizens High levels of staff satisfaction

History of Community Team plus Case for change: A sense of overwhelming demand across the system System on its head – demand defaulting to acute sector (49% of people who receive a service for the first time on discharge had approached us previously for help) High levels of res/nursing placements High levels of Safeguarding, crisis intervention The Story of ‘M’

The Story of M 7 - different agencies involved A 75 year old white gentleman with COPD and high level of involvement from health and social care. He was a frequent user of acute/non-acute bed based services. Over a 2 year period there were: 7 - different agencies involved 30 - different teams or professionals gave input 162 - acute/sub-acute beds days consumed 72 - (at least) of these were ‘excess’ bed days 66 - assessments received 869 - telecare interventions received In the most recent calendar year M had cost health and social care £40k+; we calculated that with a redesign approach, we could have reduced these costs by 25%

What we did…. In January 2014, we assembled a team of: social workers and social work assistants an OTA senior care assistants/care assistants (from our in house reablement service) Team based in the Longton area of the city, aligned to local primary and community health services Given a mandate to be accessible, be creative, resourceful and ‘helpful’ A fresh start!

‘Help me to help myself live my life well’. Purpose & Principles ‘Help me to help myself live my life well’. You fully understand me and the real problem to solve You will help me find sustainable solutions to my problems You will help me build my own networks of support You will pull in expertise as needed You will stay with me for as long as needed In addition the team applies the following ‘efficiency’ principles: Be proportionate Work in ‘real time’ to provide the help needed

How our model has evolved.. First Contact function – accessibility! Focus on Quality and Assurance (span of control) Alignment with Primary/Community health Removal of internalpurchaser/provider ‘split’ Asset-based practice and a focus on ‘what matters’ Reflective Practice Framework Performance Framework Community Networks New systems and processes Case management New arrangements with independent providers

Emerging benefits

Tier 1: Individual Outcomes and Economics Level of support estimated at start compared to actual end level of support Outcome Scores Summary Month June 2014 July 14 August 14 % with improved score 37 (55.2%) 91 (75.8%) 95 (75.4%) Change in Resilience Score Of the completed cases, almost 10% (6 cases) moved down the level of need when understood compared to initial view Initial indications show that more clients are leaving with level 1 and 2 services (advice and information/ short term services) We are showing consistent progress in meeting peoples “What Matters” demands People feel more resilient after help and support with 84% showing an improved resilience score. The other 16% have remained stable

Tier 1: Individual Outcomes and Economics Comparative costs – Recording, Assessment and weekly service cost Comparative costs – Estimated annual spend (based on average weekly cost) Assessment and recording costs have increased for the pilot cases when compared to the current delivery by an estimated £179 per case Reablement costs increased by £552 per case The projected annual service cost has reduced by £7,938 per case based on the current average weekly cost This could lead to a net cost reduction of £7,207 per case per year (assuming review/ assessment every year)

Tier 3: Strategic/Impact Measures

The volume of clients receiving domiciliary care and day care as part of a long term package of care is significantly lower than both the two comparator groups and the wider Longton ILCT CT+ put in place 84%-88% less dom care packages than the two control groups No Day Care cases 1 permanent admission into residential or nursing care compared to an average 1.5 per month for the control groups For the time period April to August 2014, 20.2% of all new clients through CT+ receiving long term support had direct payments. This compares favourably with around 8-9% for the two control groups. The numbers of clients receiving DP’s are significantly higher than the rest of the city with 2.04 direct payments per 1000 population. This outturn is 195% higher than Meir control group and 155% higher than Stoke West control group.