2. “An Ounce of Prevention is Worth a Pound of Cure.” The changing world of prevention services Strategic Prevention Event Birmingham Town Hall 07.04.11 Matt Bowsher- Regional Transformation Lead

3. Format Legislation Policy and funding Performance to date Role of Innovation New opportunities/next steps Format

4. Legislation- The White Paper “...creating new opportunities for civil society to deliver...” “...making public service markets more accessible to civil society organisations..” “...using assessment of social, environmental and economic value to inform commissioning decisions...” “...supporting citizen and community involvement in all stages of the commissioning process...” Legislation- The White Paper

5. Additional Drivers Comprehensive Spending Review NHS Reform Bill Big Society- new roles and functions all round Localism Bill Commissioning Green Paper Partnership Agreement- Think Local Act Personal Additional Drivers

6. Links to Acute Hospital Care Links to mainstream Social Care Community Equipment & Telecare Home based Social Care Re-ablement Intermediate Care in Day care setting Intermediate Care in Care home setting Home based rehabilitation Rapid response - Mobile response Acute care at home Specialist teams incl. OPMH Community Hospital beds Social Care Health Care Re-ablement Rehabilitation Means Tested Services Social Care Healthcare Free-at-Delivery Services The Prevention Spectrum Reproduced with permission from CSED

7. What appears to be in: – Follow-up outpatient attendances. – Intermediate Care - time-limited, residential or community based services, in community hospitals or other settings, designed to help people make a faster and more complete recovery from illness – Rehabilitation - medical treatment to help restore physical functioning following a hospital admission or procedure. Examples include physiotherapy following orthopaedic surgery or speech and language therapy following a stroke – Community Health services – provided by district nurses and others – Re-ablement – primarily social care services to help people with poor physical or mental health accommodate their illness by learning – or re-learning the skills necessary for daily living Potential Scope of Acute Trust Responsibility for 30 Days Post Discharge Support Services (Based on NHS PbR Guidance 2011/12)

8. What appears to be out: Pre-existing residential and home care provided by local authorities GP provided care What may be in or out: Drugs – to give clarity to the supply of drugs to patients on discharge from hospital Equipment. PbR Guidance Continued

9. Strategic Development Opportunities (1) Winter Pressures Funding (10/11) and Specific PCT Allocations for Social Care (11/12 and 12/13): – Additional Funding Stream is £162m (10/11) £648m (11/12) £622m (12/13) – Funding allocated to PCTs (Years 1 & 2) but must be transferred to councils to “invest in Social Care services to benefit Health, and to improve overall Health gain” – PCTs and councils to agree jointly on services for investment, and on the outcomes from the investment. Transparency and efficiency will be key factors, and councils will keep PCTs informed of progress using “appropriate local mechanisms” – For 10/11 local shares of the £162m “could be invested in: Additional short-term residential care places, or respite and intermediate care More capacity for Home Care, investment in equipment, adaptations and Telecare Investment in Crisis Response teams, and other preventative services, to avoid unnecessary admission to hospitals Further investment in Re-ablement services” – For 11/12 and 12/13 local shares of the £648m and £622m could be used to “support and maintain existing services, such as Telecare, community-directed prevention (such as falls prevention), community equipment and adaptations, and crisis response services”.

10. Post-Discharge Services & Re-ablement: – Additional Funding Stream is £70m (10/11) £150m (11/12) £300m (12/13) – Funding allocated to PCTs (Years 1 & 2) – PCTs to work with Councils, Foundation / NHS Trusts and Community Health Services in developing plans to “use the money to facilitate seamless care for patients on discharge from hospital and to prevent avoidable hospital re-admissions” – For local decision as to how much is spent on NHS services and on Social Care services – Some of the funding to be used to develop “current Re-ablement capacity in Councils, Community Health Services, and the Independent / Voluntary sector – according to local needs” – PCTs can transfer money to local partners, or to pooled budgets “wherever this makes sense locally” Prevention- Strategic Development Opportunities (2)

11. – From 11/12 Further additional funding will arise from PCTs not paying Trusts for certain emergency re-admissions up to 30 days from discharge – From 12/13 Trusts will have responsibility for “discharge date plus 30 days” care - so will commission and / or provide these services Prevention- Strategic Development Opportunities (3)

12. Reablement- Learning to Date Improve Operational Performance: Increase Capacity – all who would benefit from Re-ablement should get it Maximise Positive Service User Outcomes & Efficiency Gains: Improve Re-abler Productivity Include Telecare and Equipment in the Re-ablement “toolkit” Integrate Re-ablement with the SDS Delivery Process Improve Processes & Systems for Performance Management: Is all activity data collected? Do you have the information you need to manage: Re-ablement episodes for individual service users? The overall service – day-to-day, month-to-month-year-to-year? Can you convince your councillors that your Re-ablement service is cost- effective? Can you successfully make the case for more investment? Will you be able to “sell” your Re-ablement capacity to NHS Acute Trusts? (Discharge Support – from April 2012)

13. 1.Understanding utilisation and workforce productivity 2.Measurable baseline of performance 3.Smarter targeting of interventions and use of resources Understanding Performance Data Page  13

14. eABLE Simple practise step by step Real- time outcomes reporting of reablement Analysis of staff productivity and costs All stakeholders online through the web – GP’s, Community Reablement, VCS – GPs can book assessments, see availability – Families, carers, and 3 rd sector can contribute through a secure web based workflow driven case management system (as easy as booking a hotel online)

15. eABLE

16. www.asktara.org.uk A consumer experience for end users (service users, patients and self funder driven) with focus on: ease of use – simplicity – accessibility – usefulness Supporting people to self serve with less intervention Increase awareness of telecare and assistive technology products, but also: Community equipment – DPSO’s – Personal Assistants – Care Homes –Activities Increase transparency of what works (reviews) and inform commissioning practise A platform to improve commissioning outcomes, and procurement efficiencies Improve accessibility to services, promoting how to access assessment, support planning and equipment needs, spanning health and social care

17. Technology develops at pace…………….. Vs.

18. In Summary Make prevention services visible and easy to access for all Innovate to change how and when people access preventative services Use performance data and customer feedback/experience to shape and challenge prevention offer Create a prevention pathway with health partners Calculate the cost and benefit of your services and market accordingly

19. Contact Details Matt Bowsher t : 0121 245 0170 m : 07500 944 766 e : mbowsher@westmidlandsiep.gov.ukmbowsher@westmidlandsiep.gov.uk w: www.westmidlandsiep.gov.ukwww.westmidlandsiep.gov.uk blog:http://wwwjipwestmidlands.blogspot.comhttp://wwwjipwestmidlands.blogspot.com Contact Details

20. Appendix A: Top Tips from some of the best innovators 1. Get really, really close to your customers (Nokia) Involve them in identifying and developing new products or services. Make them part of your development process. Know everything that motivates them. Service Users: Nothing about me, without me. askTARA survey/ engagement 2. Make time to play (Google) Give yourself and your staff some free time to play with ideas and develop propositions. Perhaps have a regular workshop to look for new ideas. askTARA and eABLE came out of experts taking time out and playing (volunteering – Big Society). 3. Have a process that gives support for ideas (3M) Put some budget aside to do one or two projects that may succeed, but that won’t kill the business if they don’t. Expect some ideas to fail. Ensure that for example there is space for people to think, and they are adequately trained so risks can be taken. Forerunners to eABLE failed, but helped to develop thinking (SPRU, York University state legacy systems as barriers to personalisation).

21. Top Tips (2) 4. Collaborate (IBM) Talk with people in similar roles in other government departments. Identify any complementary skills, products or services and see where you could create something together. In three months, 13 councils out of 14 have collaborated to achieve a huge procurement efficiency (each authority benefitting from £70k of software and services paying just 50% of true cost), and now further potential opportunities for collaborative benefits. 5. Challenge the Status Quo (Virgin) Don’t assume that because it has always been done ‘that way’ that it can’t be improved on. One way to do this is to look at something you assume can’t be changed, and explore what the impact would be if it did. If it is about prevention and early invention, what is the impact of letting go of FACS. Existing systems and processes reinforce dependency – case management systems? 6. Reinvent your business (Philips) Sometimes going back to basics and rethinking your business goals and strategy can reinvigorate your business. If askTARA mainstreams telecare, provides a consumer experience, what is the role for Social Care and Health.