1. Post Diagnostic Support HEAT Measurement Workshop Workforce Planning and Costings 6 th February 2013 Welcome Mental Health Division QuEST Quality and Efficiency Support Team Glasgow City Community Health Partnership North West Sector

2. Identify the additional costs attached to delivering the commitment... …and in our spare time deliver world peace What we set out to do

3. Range of services and staff involved in delivering post diagnosis support Difficulty in separating out 1 st year support from ongoing support Difficulties in quantifying service redesign opportunities But we had difficulties in working out additional costs

4. So, instead we looked at the costs of just the link-worker role.

5. Estimate how many people will get diagnosed each year Estimate total number of link-workers needed to provide 1 year post diagnostic support to everyone newly diagnosed Plan a proposed split of link-worker role across different types of staff Estimate how much of the link-worker role was already happening and funded So not world peace, but not a walk in the park either. To do this we needed to:

6. South Sector Glasgow City CHP Pop. 126,194 (Over 30) and 27,023 (Over 65). NRS – GRO Figures 2010. Approximately 25% of the population live in income deprivation. 16% live in income deprivation in Scotland as a whole. Relatively higher mortality, poorer physical and mental health. Dementia incidence using Eurocode - 327.

7. Challenge One and Two Estimating how many people will be diagnosed with dementia each year in your area Estimating total number of link-workers needed to provide 1 year post diagnostic support to everyone newly diagnosed

8. But only info on who diagnosed in specialist services… …Glasgow unusual – most areas don’t even have this

9. We can predict new diagnosis using population estimates but its complicated and there will be margins of error Number of people actually diagnosed at a given moment in time Estimated prevalence = total predicted number of people in your area with dementia at a given moment in time Estimated annual incidence = predicted number of new people per year developing dementia HEAT Standard is that at least 50% of the total predicted population with dementia should have a diagnosis. As the population is aging the actual number needed to meet 50% increases each year South Glasgow 2013 = 2,646 1414 (53%) South Glasgow 2013 = 327 1232 South Glasgow 2013 = 320 Estimated annual mortality but don’t know how many of those are diagnosed. Number of people with dementia but not diagnosed So if maintaining their current performance against the HEAT standard, South Glasgow will expect to diagnose between 175 -324 people a year

10. Step 1 Estimated number of people newly diagnosed with dementia

11. Challenge Three Estimating how the link-worker role will be split across different profession

12. Step 3 Planning your staff profile for linkworker role Moving most of early intervention input to non- health providers, but keeping strong links to OPCMHT and consultant referrers. –Alz Scot Link worker. 70% –C.P.N. 20% –O.T. 10% Linking clients with appropriate support skill level. Reducing cost/releasing specialist health resources for moderate or severe.

13. Planning staffing profile cnt/d Based on local model/local circumstances. Change Fund money to employ 2 WTE Alzheimer Scotland Link Workers in Sept 2012. OT in self management. Strong links to other services Social Work – Carers Support Service. Must be strong links with Social Work. Dementia Advisor. MacMillan Partnership – Financial/legal.

14. Step 4 Costing proposed staff profile for linkworker role

15. Challenge Four Estimating how much of the link worker role is already happening and funded

16. Step 5 Who is currently doing the role? This is difficult to collect and self estimates not likely to be accurate

17. Step 5 Who is currently doing the role? South Glasgow now piloting an activity tracker to audit over a 2 week period how staff actually spend their time.

18. Step 6 Working out the difference 1.You’ve estimated the total numbers and costs of staff you need to deliver the target 2.You’ve estimated the total amount of time by different staff currently spent on PDS in the 1 st year post diagnosis 3.So the additional staffing/funding you need is simply 1-2 4.But not quite that simple….

19. These calculations assume any reduction in current staff time spent on PDS are not cash releasing Marginal costs of meeting target£43,748 Value of staff time released for other work£60,652 Total hours of staff time released per week for other work (assumes 37.5 per WTE)70 These calculations assume any reduction in costs through redesign are cash releasing and hence available for reinvestment in PDS. This is less likely to be the case than the above scenario. Net Marginal Costs -£16,904 The tool then automatically works out marginal staffing costs for the linkworker role

20. Step 7 Additional costs associated with link-worker role

21. The tool then automatically gives you a summary of overall total and marginal costs

22. Key lessons learnt - costing Not possible to fully cost impact of target too many uncertainties Variation in current funding Ranging from 58% – 100% of projected linkworker costs 3 sites currently using change fund to part fund linkworker costs (fixed term 2014/15)

23. South Glasgow lessons learnt using the tool Emphasis on non health providers but with strong links to local mental health team and referral pathways. Strong links with social work/social care providers. Balance between ideal and what is practical/affordable Tool is a useful planning resource for HEAT target.

24. Questions/Discussion Utility of Tool: Would you use this tool to facilitate PDS planning? What are your thoughts/comments? Who: From your own area – can you identify the core professionals who you think will undertake the one year link worker role? From this group, how would you see the professional mix? Why? How: What would your local model look like? How and where would your PDS link workers operate in your area? (For example, where would they be based? Would they be part of a discrete team or linked to other teams?) What would the patient’s journey look like in your model? Could you draw a diagram? Change: What would you need to do/change to make this happen?

25. Thank you for attending Mental Health Division QuEST Quality and Efficiency Support Team Glasgow City Community Health Partnership North West Sector