1. “One size fits one” Dr Margaret Hannah Deputy Director of Public Health

2. “One size fits one” In pairs, take two minutes each to describe the life circumstances of an older person you know. The person may still be alive, or may not. What is important to them? What would make a real difference?

3. Current ways of working are unsustainable 76% rise in multiple emergency admissions in people > 85 in 10 years Community team case loads increased by 40% in 3 years Community hospital beds occupied by people better cared for at home

4. What did we aim to do? Discover and nurture a health economy based on new sources of abundance: –The resourcefulness of our Staff –The creativity and willingness of our Community to provide innovative ways of helping older people thrive Build a sustainable infra-structure to grow this Release locked-in resources from existing provision to support this in the long term

5. Learning so far This is a radical culture shift! Staff need support and permission to do things differently Deep down they recognise it is the right thing and what they want for people Clients too need time to adjust to a new way of thinking about things

6. Learning so far Wealth of enthusiasm and creative solutions from the community “Devil is in the detail” – ensuring small scale solutions are safe, sustainable and legal requires patience and perseverance A little bit of hope goes a long way

7. A story “I feel human again” “I am doing things that I want to do and feel independent” Staff have noticed an improvement in mood and sense of well-being “Great to see how small changes can make a big difference to someone’s life” 6 days less at day hospital (£1092 saved)

8. Micro – providers (Safe, legal and sustainable)

9. Results 6 older people receiving different types of support 30 staff trained to work in this way 15 micro-providers supported in a growing network Carlisle Ward has closed (a leap of faith) Integration with wider community capacity building work, SDS and reshaping care agenda Central and local funding obtained for Phase 2