1. The Journey from Care Homes to Care at Home “ “Living at Home Safely for Longer” Cherry Dunk/Jane Cashmore – Notts County Council Contracting and Commissioning Conference Sept 2014

2. The start of the journey…2011 Nottinghamshire higher spend on care homes - 43% compared to 31% England average Poor performer on balance of Residential Care v Care at Home. A bumpy road ahead “Alternatives to Residential Care” Project

3. Comparison: Residential Care Numbers Per 100,000 Population

4. The Journey Set targets to:- –Reduce numbers admissions to care –Rebalance budget from Res Care Homes to Community Care –Improve our care at home offer

5. Why were people being admitted into care homes? Trigger Points Admission following a stay in hospital (65%) Short Term Admission (40%) became Long Term Carer breakdown Deterioration in health

6. The Journey NCC admissions compared to other L/A’s Reasons for admissions Proposals for reducing admissions Opportunities for Joint Working

7. Improving Community Services Extra Care Strategy/Sale of Care Homes Virtual Extra Care – Night Response Service MHIC Teams AT – ‘Just Checking’ & AT for carers Assessment Beds Culture change workshops

9. Re launch as “Living at Home Safely for Longer” Programme

10. Culture How? Early Intervention and Reablement Early Intervention and Reablement Joint working and Integration with Health Joint working and Integration with Health Care and Support Centres Care and Support Centres Admissions to Care Admissions to Care Extra Care Assistive Technology Assistive Technology Promoting Independence and “Living at Home”

11. Living at Home Home Based Support Services Tender jointly with Health Extra Care Procurement – capital investment Partnerships with Districts & Borough Councils Support for people with Dementia Admissions to Care 24 hour response service Robust reporting and monitoring

12. Challenges Increased financial pressures Culture of risk aversion Managing the market e.g. managing the numbers of care homes and also enabling innovation New ASCH Strategy Impact of Care Act Political environment

13. Successes Extra Care Developments Countywide MHICS/ IRIS Team Reductions in LTC placements Implementing Home Based Care Contracts – 4 Core Providers Use of A.T. i.e. Just Checking

14. Lessons Learned (some of!) Culture change is vital –Both within and external to the Department –Enable older people to live independently and maximise their support services –Work to build relationships with our partner agencies –Buy in from key people –Good communication –Relevant systems/processes in place

15. Lessons Learned (some of!) It will take a lot more time than you anticipate Keep your foot on the pedal so that none of the plates stop spinning Be flexible to change –Be prepared to take alternative routes along the journey where necessary

16. Questions/Discussion What else could we do? How have others changed culture?

17. Thank You

18. Cherry Dunk – Group Manager, Strategic Commissioning 0115 9773268 cherry.dunk@nottscc.gov.uk Jane Cashmore – Commissioning Manager, Joint Commissioning - Older Adults 0115 9773922 jane.cashmore@nottscc.gov.uk cherry.dunk@nottscc.gov.uk jane.cashmore@nottscc.gov.uk