1. Promoting Independence: changing the model for social care in Norfolk Norfolk Older People’s Strategic Partnership Board September 2015

2. The drivers for change: Outcomes and expectations are changing Patterns of ageing are changing The Care Act is changing entitlements and responsibilities The pressure on public funding and very real cuts in local authority budgets mean we need to refocus LA funding.

3. In comparison with our ‘family’ of shire counties, Norfolk’s pattern of services shows: A very high number of people contact the Council about social services We formally assess twice as many people as our comparator authorities A high level of older people admitted permanently to residential care homes There is a good track record of enabling people to stay independent after discharge from hospital through reablement A very low number of discharges from hospital are delayed because of social care A very high number of admissions to residential care are made from hospital A relatively low number of carers use self-directed support People using care services in Norfolk generally feel safe and well supported: they generally feel very satisfied with their care. How does Norfolk compare with elsewhere?

4. Contacts to social services Norfolk has lots of contacts

5. Assessments And turns a greater proportion of these into assessments and then into service users

6. Numbers of people admitted to permanent residential or nursing care for people 65+ What this measures: The number of people aged 65+ being permanently admitted to residential or nursing care per 100,000 population aged 65+ 2014/15 data Notes and comments: Similar position to last year – towards the upper end of the family group, though not as significant an outlier as the 18-64 rates What this is telling us: Norfolk’s rate still seem a little high, particularly given lower levels of short term, and even overall long term, support

7. Percentage of residential and nursing care placements referred from hospital for people 65+ What this measures: The % of residential and nursing care placements that were referred directly from hospitals for people 65+ 2014/15 data Notes and comments: Included here because a developing hypothesis is that Norfolk receives excessive referrals from hospitals Follows on from last slide re: high overall hospital referrals into short term social care What this is telling us: Norfolk is highest in its family group, and very high overall Significant lead for further investigation – people are obviously going into residential care following a crisis, via hospitals. What is driving this? The John Bolton delayed discharges hypothesis? Market failure in other (homecare) settings?

8. Adult social care budget for 14/15: £242m Current predicted overspend: £5.5m Anticipated gap in NCC funding over next three years: £110m Translates into over £50m reduction of ‘addressable spend’ in adult social services over the next 3 years. The financial position:

9. Involvement in your community Getting better after being ill Getting early help when you need it Getting support for your complex health needs Running your own life – making choices and decisions Looking after yourself Keeping well & recovering your health Living with complex health conditions Getting information and advice Managing your long term health condition Promoting Independence Living independently at home Excellence in education Real jobs Quality of life for vulnerable people

10. Making the difference: early focus Work with District Councils on local information, community development Consider a locally based ‘clinic’ approach to assessment to strengthen community links (Staffordshire model) Ensure reablement is working to best effect – increase access Rework assessment and review processes to strengthen independence, link to community assets, review Personal Budget allocation process Build on integration to ensure smart working with NHS Progressing development of housing with care.

11. Making the difference: wider changes? What really makes a difference for older people and their families? How do we make the most of what communities have to offer? How do we change culture and assumptions?