The English Elderly Care and Support System British-Poland Panel Discussion on Healthy Aging – 28 th January 2014 Glen Mason Director of People, Communities and Local Government Department of Health DH – Leading the nation’s health and care

2 Care and Support affect a large number of people Many people need some extra care and support during their adult years to lead an active and independent life. Three-quarters of people aged 65 will need care and support in their later years… And even if we don’t need care ourselves, we will all know someone – a family member or friend – who needs care and support. 5 million people in England currently care for a friend or relative. DH – Leading the nation’s health and care UNCLASSIFIED

3 Supported …and around 5 million people caring for a friend or family member. …around 310,000 people in residential care, 60% of whom are state-supported …around 680,000 people in domiciliary care, 60% of whom are state-supported …1.8 million people working as care professionals In England there are … Supported …and around 5 million people caring for a friend or family member. …around 310,000 people in residential care, 60% of whom are state-supported …around 680,000 people in domiciliary care, 60% of whom are state-supported …1.8 million people working as care professionals … Care and support affects a large number of people DH – Leading the nation’s health and care UNCLASSIFIED

4 Older Persons Population In 2012 just over nine million people in England (15% of the population) were over the age of 65 and over 1 million people were over the age of 85 There are 800,000 people living with dementia and it is forecast that 1 in 3 people currently over 65 will develop dementia 178,000 people receiving direct payments More and more people are living with one or more long term conditions e.g. heart disease, hypertension, diabetes, etc. On 31st March 2012 there were 651,130 older people being supported by adult social services (councils) in England –Of these 480, 575 were living in the community –With 170,555 living in residential or nursing care DH – Leading the nation’s health and care UNCLASSIFIED

5 The Social Care Workforce Size of the workforce 1.85 million jobs with 1.63 million people doing them 22,000 employers (most private sector) 18,500 employers employ less than 50 staff (12,000 employ less than 10) Percentage of jobs – 655 private sector, 23% individuals, 9% local government, 4% NHS About 60% of care staff are qualified DH – Leading the nation’s health and care UNCLASSIFIED

Right Capacity GPs 40,265 Consultants 40,394 Registrars 39,404 GP practice nurses 23,458 Support to doctors & nursing staff 269,714 Support to ambulance staff 13,451 Central functions 106,696 Hotel, property and estates 71, 242 Manager and senior manager 37,314 Qualified ambulance staff 18,645 Allied health professionals 74,902 Healthcare scientists 31,173 Other scientific, therapeutic & technical staff 47,490 GP providers 26,886 Estimated number of NHS hospital & community health service and general practice workforce as at 30 September 2012: 1.36 million Professionally qualified clinical staff 687,810 Other doctors in training and equivalents 13,952 Other medical and dental staff 12,302 Other GPs 8,898 GP registrars 4,426 Qualified nursing, midwifery & health visiting staff 346,410 Support to clinical staff 343,927 Infrastructure support 215,071 Nursing 369,868 Doctors 146,075 Scientific, therapeutic & technical 153,472 Support to scientific, therapeutic & technical staff 61,345 Residential 675,000 Domiciliary 831,000 Estimated number of adult social care jobs by employer type in England, 2011: 1.85 million Day 96,000 Community 251,000 Other GP practice staff 113,832 Direct care 776,200 Managerial/supervisor y 31,700 Other 18,400 Professional 4,300

7 English Care System Assessment of need by 152 local Councils Eligible for services – 4 eligibility thresholds (low 1%, moderate 13%, substantial 83% and critical 2%) and a financial assessment 60/40 split state funded/self funded Direct payments must be offered 70% Community Services designed to keep people living at home as long as possible. 30% services residential and nursing Growing importance of rehabilitation services Interrelationship with health – preventing unnecessary hospital admissions, reducing length of hospital stay and preventing ‘blocked beds’ DH – Leading the nation’s health and care UNCLASSIFIED

8 Drivers for Change in the English Care System Demographic pressure –As a country we are living longer and almost all of us will need care –Medical improvements also mean more people with disabilities are living longer in adulthood. –Most of us will need care and support at some point in our lives Unprecedented financial challenges –Need £10bn in more savings –Public spending – reduction of £80bn in four years –Economy will be 10-15% smaller than we thought it would be Raising expectations DH – Leading the nation’s health and care UNCLASSIFIED

9 We will change care and support in two fundamental ways: The Care and Support Bill – our vision 1. The focus of care and support will be to promote people’s independence, connections and wellbeing by enabling them to prevent and postpone the need for care and support. 2. We will transform people’s experience of care and support, putting them in control and ensuring that services respond to what they want. DH – Leading the nation’s health and care UNCLASSIFIED

10 “I” Statements 1. “I am supported to maintain my independence for as long as possible” 2. “I understand how care and support works, and what my entitlements are” 3. “I am happy with the quality of my care and support” 4. “I know that the person giving me care and support will treat me with dignity and respect” 5. “I am in control of my care and support” DH – Leading the nation’s health and care UNCLASSIFIED

11 Priorities Shifting the system from a focus on crisis to prevention Making choice and control a reality Drive improvement in the quality of care throughout the system Integration between Health and Social Care DH – Leading the nation’s health and care UNCLASSIFIED

12 DH – Leading the nation’s health and care UNCLASSIFIED Shifting the focus – from crisis to wellbeing Need for intensive care and support Living well Low-level needs Crisis People will be given better information and advice to plan ahead to prevent care needs, and will be better connected to those around them. More support within communities, better housing options and improved support for carers will help people maintain their independence and avoid a crisis. Re-ablement services and crisis response will help people regain their independence at home after a crisis. The new system will promote wellbeing and independence at all stages to reduce risk of people reaching a crisis point, and so improve their lives

13 DH – Leading the nation’s health and care UNCLASSIFIED Choice, control and quality People can choose between a range of high quality options, or create their own People develop their own care and support plan People have clear information to make good choices about care People are in control of their own budget People’s views are heard and help improve services In the new, person-centred system... i

14 DH – Leading the nation’s health and care UNCLASSIFIED

15 Benefits of integration Better use of existing resources for health and care services Better use of existing resources for health and care services Co-ordinated approach to health and social care Putting users at the heart of the service Better outcomes for users Bring together a greater range of skills and expertise Bring together a greater range of skills and expertise Access to care and support 7 days a week Reduction in demand on acute services DH – Leading the nation’s health and care UNCLASSIFIED

16 Examples of where it’s happening In Greater Manchester the 10 authorities and 12 Clinical Commissioning Groups have joined forces to support the largest reconfiguration of hospital services in the National Health Service. Projected to save £270 million over 5 years. In Greater Manchester the 10 authorities and 12 Clinical Commissioning Groups have joined forces to support the largest reconfiguration of hospital services in the National Health Service. Projected to save £270 million over 5 years. Pioneers In November 2013 the Department of Health announced the 14 pioneers which will lead the way in co-ordinated care. These pioneers are driving the integrated care agenda forward by taking innovative new approaches in transforming the way health and care services are Delivered. Pioneers In November 2013 the Department of Health announced the 14 pioneers which will lead the way in co-ordinated care. These pioneers are driving the integrated care agenda forward by taking innovative new approaches in transforming the way health and care services are Delivered. In Greenwich 2,000 patient admissions have already been avoided thanks to interventions by the Joint Emergency Team. The team responds to alerts within care homes, A & E departments and GP surgeries. In Greenwich 2,000 patient admissions have already been avoided thanks to interventions by the Joint Emergency Team. The team responds to alerts within care homes, A & E departments and GP surgeries. At South Devon and Torbay they have found that by bringing professionals closer together it has cut waiting times. Patients used to have to wait 8 weeks for physiotherapy service, now they wait only 48 hours. At South Devon and Torbay they have found that by bringing professionals closer together it has cut waiting times. Patients used to have to wait 8 weeks for physiotherapy service, now they wait only 48 hours. The Tri-borough calculated that 20% of the local population account for 77% of health and social care costs. It’s new model designed to help people manage chronic conditions more effectively and reduce hospital admissions, is estimated to deliver £38m net savings per year. The Tri-borough calculated that 20% of the local population account for 77% of health and social care costs. It’s new model designed to help people manage chronic conditions more effectively and reduce hospital admissions, is estimated to deliver £38m net savings per year. DH – Leading the nation’s health and care UNCLASSIFIED

17 What is Government doing to support this? The Better Care Fund June 2013 announcement: £3.8bn to be deployed locally in 2015/2016 on health and social care through pooled budget arrangements June 2013 announcement: £3.8bn to be deployed locally in 2015/2016 on health and social care through pooled budget arrangements To assist areas in preparing for the Better Care Fund, an additional £200m will be provided in 2014/2015 Draft plans to be submitted in February with finalised plans to be agreed in April Local authorities and NHS Clinical Commissioning Groups must agree a joint plan to deliver better, person-centred care before receiving funding Part of the £3.8bn allocated to local authorities includes a payment for performance element to incentivise ambition and real change Autumn Statement December 2013: Pooled budgets will be an enduring part of framework in future years Autumn Statement December 2013: Pooled budgets will be an enduring part of framework in future years DH – Leading the nation’s health and care UNCLASSIFIED

18 Thank you and any questions? Glen Mason Director of People Communities and local Government Department of Health DH – Leading the nation’s health and care UNCLASSIFIED