1. CARE SERVICES IMPROVEMENT PARTNERSHIP Regional Planning for an Ageing Population Housing Learning & Improvement Network 12 May 2006 David Johnstone Director Adult & Community Services Devon County Council

2. THE VISION FOR PUBLIC SECTOR SERVICES Promoting independence Promoting independence Empowerment of individuals and communities Empowerment of individuals and communities Mixed market of provision – no public service monopoly Mixed market of provision – no public service monopoly Self-managed care Self-managed care (Self-funded care) (Self-funded care) Performance managed – outcome focussed Performance managed – outcome focussed Failing organisations taken over Failing organisations taken over

3. THE DRIVERS Demography Demography Ageing population Ageing population Declining numbers in workforce Declining numbers in workforce Cost Cost Ageing population Ageing population Health care advances Health care advances Rising expectations Rising expectations Values Values Vision Vision

4. Our Health, Our Care, Our Say FOUR CENTRAL AIMS Better health and wellbeing Better health and wellbeing Convenient access to high quality services Convenient access to high quality services Support for those in greatest need Support for those in greatest need Care in the most appropriate setting, closer to home Care in the most appropriate setting, closer to home(5.10)

5. THE MESSAGE (1) “All public services should put the person who uses them at their heart” “All public services should put the person who uses them at their heart”(1.1) “Twentieth century health and social care was rooted in institutions and dependence … in future more care will be presented in more local and convenient settings” “Twentieth century health and social care was rooted in institutions and dependence … in future more care will be presented in more local and convenient settings”(6.1/6.2)

6. THE MESSAGE (2) “The challenge is also for each of us as individuals to take responsibility for our own lifestyles and aim for a healthy, fulfilling old age” “The challenge is also for each of us as individuals to take responsibility for our own lifestyles and aim for a healthy, fulfilling old age”(1.24)

7. THE VISION (1) “It is important to be clear from the outset that we see a new direction for the “whole system”. This refers to all health and social care systems in community settings” “It is important to be clear from the outset that we see a new direction for the “whole system”. This refers to all health and social care systems in community settings”(1.29)

8. PREVENTION AND SELF- CARE “Services should support people to take greater control over their own lives … there needs to be a greater focus on prevention” “Services should support people to take greater control over their own lives … there needs to be a greater focus on prevention”(5.11) “We need to move from fragmented to integrated service provision, from an episodic focus to one of continuing relationship” “We need to move from fragmented to integrated service provision, from an episodic focus to one of continuing relationship”(5.13)

9. CHANGING DEMOGRAPHICS

10. IMPACT OF AGEING POPULATION “It has been estimated that the number of people over 65 years old with a long-term (ill-health) condition doubles each decade” “It has been estimated that the number of people over 65 years old with a long-term (ill-health) condition doubles each decade”(1.20) “The number of people over 85 …. is expected to double by 2020” “The number of people over 85 …. is expected to double by 2020”(1.20)

11. HOW DO WE AFFORD THIS? Health Promotion Health Promotion –1% reduction in health morbidity will generate 30% savings (or £6.3bn) per annum Give greater priority to integrated care within the community Give greater priority to integrated care within the community –Community Resource Centres –Timely and targeted care at home –Development of extra care housing –Managed supply of residential and nursing care Make better use of existing resources Make better use of existing resources

12. SHIFTING RESOURCES “A system like today’s NHS - which channels people into high-volume, high-cost hospitals – is poorly placed to cope effectively with increasingly elderly and increasingly long-term ill heath”(1.22) “A system like today’s NHS - which channels people into high-volume, high-cost hospitals – is poorly placed to cope effectively with increasingly elderly and increasingly long-term ill heath”(1.22) “ A strategy centred on high-cost hospitals will be inefficient and unaffordable”(6.2) “ A strategy centred on high-cost hospitals will be inefficient and unaffordable”(6.2)

13. WORKING PRACTICES “Seeing old age as a ‘problem’ is of relevance to the provision of incomes in old age. Healthcare, transport, the facilities for daily life which everyone takes for granted in their youth and middle years.” Royal Commission pg 3 “There is now a clear opportunity to see old age for what it is, a stage of life where we have the gift of time to be able to acquire knowledge and experiences… People should not necessarily be assumed to be passive recipients of the goodwill of others or inevitably incapacitated, befuddled or redundant.” Royal Commission pg 4

14. “WHOLE SYSTEM” APPROACH “It is important to be clear from the outset that we see a new direction for the “whole system”. This refers to all health and social care systems in community settings” “It is important to be clear from the outset that we see a new direction for the “whole system”. This refers to all health and social care systems in community settings”(1.29)

15. WORKING PRACTICES The important role of Housing “The other principle source of support to sustain independent living in the community is the local housing authority and other housing providers. Suitable housing provides a stable base for independent living and affords access to other services such as health and social care, education and training. The housing service is also an important source of practical assistance for many people, often being the first point of contact with the local authority, as well as being highly accessible.” Audit Commission, ‘Home Alone’, pg 6

16. NATIONAL SYSTEMS Complex and Confused “Confusion and uncertainty exist as an intrinsic part of the current system.” Royal Commission pg 38 “Confusion and uncertainty exist as an intrinsic part of the current system.” Royal Commission pg 38 “[It is] characterised by complexity and unfairness in the way it operates. It has grown up haphazardly over the years.” Royal Commission pg 33 “[It is] characterised by complexity and unfairness in the way it operates. It has grown up haphazardly over the years.” Royal Commission pg 33

17. IMPROVE WORKING PRACTICES Insufficient integration Insufficient integration Modest expectations on the part of the public Modest expectations on the part of the public Must address the whole range of needs in an integrated way Must address the whole range of needs in an integrated way Quality and sensitivity of provision is important to users of services Quality and sensitivity of provision is important to users of services –material aspects –the nature of the personal relationship

18. THE WAY FORWARD More effective joint working and sharing of responsibility between health, housing and social services More effective joint working and sharing of responsibility between health, housing and social services Greater emphasis on Greater emphasis on –Effective preventative services –Health improvement –Rehabilitation and recuperation More consistent and integrated assessment of need More consistent and integrated assessment of need More support to carers More support to carers Sensitive services Sensitive services Emphasis on quality Emphasis on quality Services easier to access Services easier to access Integrated and inclusive strategic planning Integrated and inclusive strategic planning New relationship of trust New relationship of trust

19. HAVE WE THE WILL? HAVE WE THE SKILL? To establish effective joint strategic planning systems which are inclusive of all partners? To establish effective joint strategic planning systems which are inclusive of all partners? To invest in effective preventative care? To invest in effective preventative care? To develop integrated services? To develop integrated services? To develop a continuum of linked services? To develop a continuum of linked services? To make a confused system work better, and to regain trust and confidence? To make a confused system work better, and to regain trust and confidence?