The Torbay Model – meeting people’s needs and expectations Dr Carol Tozer People Commissioner

Looking at tomorrow and over the horizon Number of people aged over 85 will double by 2026 to about 2 million: number of people over 100 will have quadrupled Currently – about 4 people under 65 for every person; by 2029 this will be 3 people Healthy life expectancy is falling behind life expectancy – people are spending longer time living with conditions that seriously affect their quality of life (effects of stroke; diabetes; dementia etc)

And in Torbay… – 36,800 people aged over – 3,700 people over – 42,500 people aged over – 5,400 people aged over – 61,200 people aged over – 10,100 people aged over 85

Evidence that people’s needs are being met: CSCI 2008 reported: 25% people seeking help fell outside Councils’ eligibility criteria Of those not receiving help: 35% people said they managed without; 32% got help from family members; 23% made private arrangements; 10% were helped by a voluntary organisation 1:5 people identified themselves as carers – and 1:8 of those who could benefit were not offered an assessment of their needs

Much is changing The white paper (finally) published 30 March 2010 establishing proposal for National Care Service Further evidence of worsening pressures on the social care system – tighter eligibility criteria Growing impact of recession on needs and resources – soaring levels of public debt, inevitably affecting views about affordability and sustainability Putting People First – signalling new delivery model based on personalisation New policy initiatives in relation to dementia, carers and learning disability Forthcoming election

Carers at the Heart of 21 st century Families and Communities Cross cutting government strategy sets out actions for next 10 years covering breaks, income, information and advice, the workplace, training for the workforce, access to employment, emotional support, the health of carers and the specific needs of young carers (DH 2008)

Valuing People Now 3 year cross cutting strategy for people with learning disabilities – stressing independence, rights and choice. Predicts that numbers of people using services is due to increase by more than 50% to 223,000 by 2018

Living well with dementia: a national dementia strategy Recognises that people with dementia will double over next 30 years to 1.4 million and that costs will treble to more than £90 billions per annum (DH 2009) Early identification, development of specialist skills and new models of service delivery at the heart of the strategy

The white paper sets out Principles of: affordability; fairness; consistency; and self determination Proposals for a National Care Service Free care and support for those with the greatest needs BUT – creates (another) Commission to develop the contribution and funding proposals – and new system will not start until after the next Comprehensive Spending Review period

Domiciliary Care Expenditure in the Independent Sector 2009/102008/092007/08 Older6,3015,1423,251 Learning Disabilities1,4861, Mental Health Under Total7,9576,5944,377 Notes: 1) The above is expenditure in relation to the independent sector areas and does not include in house expenditure 2) From 2008/09 Older People Domiciliary Care expenditure includes Sandwell block payment (approx. £1.45m per annum)

Residential & Nursing Expenditure in the Independent Sector 2009/102008/092007/08 Residentia lNursingTotal Residentia lNursingTotal Residentia lNursingTotal £000s Older13,8352,91516,75013,4853,28816,77311,9593,56815,527 Learning Disabilities3, ,3863, ,3713, ,395 Mental Health Under 651,8150 1,5740 1,8260 Preserved Rights3,0900 3,2720 3,3420 Total21,9923,04925,04121,4963,49424,99020,3223,76824,090 Notes: 1) The above is expenditure in relation to the independent sector areas and does not include in house expenditure 2) The above is inclusive of short stay. 3) From 2008/09 Older People Residential expenditure includes Sandwell block payment (approx. £800k per annum)

Snapshot of Day Care Numbers as per Client Category 2009/10 (Based on Resource Allocation Sample Work) Independent Sector Care Type Q31 - Mental Illness Q32 - Dementia Q40 - Phys Dis Q43 - All SensoryQ44 - FTI Q50 - Learning Dis Q70 - Vul PeopleTotal Day Care In House In House Older Day In House LD Day 126 Total Total % of total2%9%25%2%15%44%2% Notes 1) This is a snapshot of client numbers for 2009/10 that is representative of the financial year. 2) In House figures have been included due to the high proportion of market share specifically within Day Care.

How well in Torbay Number of in-borough homes:117 Residential homes:100 Residential & Nursing homes:17 CQC Rated: Poor – 0 Adequate –15 Good –73 Excellent –27 Not Yet Rated - 2

The Torbay Model From: “Right care, right time, right place” To: “Right advice and information, right person, right money”. Commissioning and brokerage activities, development of social capital and audit – placed centre stage

The Torbay Model means The development of third sector organisations and neighbourhood provision is vital The organisational divisions between adult social care and the NHS, housing, access to benefits, access to employment support must be overcome And providers must diversify and adapt to the new marketplace.

Moving forward - together Torbay people are most likely to experience the best outcomes if providers and commissioners work together to establish the ingredients, recipe and menu of transformation locally Together, we must maintain and develop new local models of best practice Together, we must establish clear protocols and ascertain a shared understanding of roles and responsibilities of all those involved in end of life care

Thank you Dr Carol Tozer People Commissioner