1. SSIA Webinar – 17th February 2011
Better Support at Lower Costs Improving efficiency and effectiveness in services for older people in Wales
Professor John Bolton
Consultant
JRFB Ltd
SSIA Webinar – 17th February 2011

2. Background and Context
4% efficiencies to be found for next 3 years
New charging rules for community services (Ceredigion)
Reducing admissions to residential care (Monmouthshire, Flintshire, Blaenau Gwent, Neath Port Talbot and Gwynedd Future Plans)
Joint Strategies with Health (Cardiff and Vale of Glamorgan, Bridgend, Pembrokeshire and Torfaen with Joint Directors Posts)
Development of reablement (Merthyr Tydfil, Monmouthshire, Rhonda Cynon Taf, Bridgend, Anglesey, Swansea, Neath Port Talbot)
Some excellent medium term strategies (Carmarthenshire, Conwy, Denbighshire, Anglesey, Bridgend, Powys, Cardiff, Wrexham and Gwent Councils (Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen)
Some excellent analysis for action (Ceredigion, Gwynedd, Carmarthenshire, Conwy, Neath Port Talbot, Merthyr Tydfil, Rhonda Cynon Taf, Powys)

3. Reduced use of residential care

4. Spend on Residential and Nursing Care

5. Strategic Direction
Most strategies focus on continued reduction in demand for residential care
Most strategies focus on use of reablement
Some strategies are working joint with Health
Some strategies are looking at extra care housing
Some strategies are linked to medium term financial planning
Some confusion over “helped to live at home” and “prevention”

6. Older People helped to live at home also reducing

7. Of those getting help – more are receiving this at home

8. Helping people at home does not necessarily mean lower use of residential care

9. The Oxford seven (The Institute for Public Care – Oxford Brookes University)
How do local authorities work with health to ensure that older people are getting the right health care?
The most common health reasons why an older person might need residential (intensive) care
Dementia
Incontinence
Urinary Tract Infections/ Hydration
Strokes
Podiatry
Dental
Falls
Why are these the areas where some health communities perform poorly?

10. Admissions to residential care from hospital

11. Admissions to residential care as a percentage of all discharges

12. Successful strategies
10% reduction in demand for domiciliary care through successful reablement with health
20% further reduction in demand for residential care through better use of intermediate care with health
Needs stronger dialogue with health about services needed by older people ( dementia care, incontinence, podiatry, falls, stroke etc.)
Needs greater use of assistive technology
Needs better understanding of role of housing
Needs greater use of Direct Payments
Needs better understanding of costs to ease collaborative procurement
Needs better commissioning including in-house
Needs lean thinking for process design
Needs system that helps keep older people out of social care

13. 31 ways to save money Reablement/ Intermediate Care
Telecare and Equipment
Direct Payments (PAs)
Reduce use of residential care
(Citizen contributions)
Housing with care models
Housing advice and DFGs
(Employment and Training)
Work with Health
Lean process
Better commissioning
Externalise services
Mobile Working
Reviews
Procurement (collaborative)
Skills Mix
Big Society - Volunteering
Screening
Continuing Health Care
Targeted prevention - falls
Stricter eligibility
Management and Team structures
Customer contact
Sickness absence
Electronic Care Records
Productivity Management
Changing culture
Administration/ IT solutions
Personalisation – (RAS and PBs)
Job carving
Children's Transitions
Patient self-management

14. Transformed Care System
Universal Services
Information and Advice – including self- funders
Community Offer – social capacity
Health Services
Welfare Rights Advice
Targeted Interventions
Equipment and Aids to daily living and Telecare Products
Intermediate Care and Re-ablement
Supported Housing
DFGs/ Adaptations
Care and Repair
Falls clinics and other
Care and Support
Eligibility Threshold
Assessment and Care Management
Choice and Control
Direct payments
Supply
Commissioning the right range of services
Macro and Micro procurement
Contracts and Spot Purchasing
Cost and Volume of supply
28 May, 2018
Nordic; Presentation March 17/18

15. The challenges in Wales
Understanding the demographic challenges
The impact of new charging arrangements
Can health and social care work together?
Housing as part of the solution?
Paternalism and low level services – clarity on prevention
Developing use of assistive technology
Collaborative procurement
Learning best from each other

16. A new model of social care
That builds on keeping people out of social care
That builds on interventions at a time of crisis
That focuses on non-institutional solutions
That builds on health and social care interdependence
That challenges people to be responsible for managing their own care
That uses the money more effectively
That is evidence based
BUT that does not meet the current requirements of government policy and regulation

17. For more help………. John Bolton SSIA Independent Consultant 07789 748166
SSIA