Hampshire County Council

Executive Member - Adult Social Care Item 2

28 July 2006

Setting Future Direction for Older Persons Services

Report by the Director of Adult Services

1.

Summary

1.1

The following decisions are sought:

That the:-

Executive member is asked to endorse the strategic direction for Older Persons services including the following specific actions:-

1) The development of a strategy to access universal services to support Well Being and independence of older people to ensure social care resources are targeted to those with greatest need thus supporting financial recovery

2) The development of a Commissioning plan for Older People that supports the delivery of sustainable financial recovery and joint working with key stakeholders and partner organisations

3) Development of comprehensive plans to refocus In House Services to deliver a modernised cost effective service that is integral to the overall commissioning plan.

2

Other options considered and rejected

None.

3

Conflicts of interest declared by the decision-maker or other Executive Member consulted

None.

4

Dispensation granted by the Standards Committee

None.

5

Reason(s) for the matter being dealt with if urgent

Not Applicable

Approved by:

..........................

Date of decision:

Councillor Patricia Banks

Hampshire County Council

Executive Member - Adult Services Item 2

28 July 2006

Setting Future Direction for Older Persons Services

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

This scheme will impact on the delivery of the following Corporate Aims

Aim 1 - maximising life opportunities by assisting timely delivery of caring services

Aim 5 - making sure services continuously improve

1.

Summary

1.1

The purpose of this paper is to set the context both nationally and locally for the future direction of Older Persons Services in Hampshire. The drivers for these changes are national policy, the demographic changes in the population of older people who live in Hampshire, their changing needs and the financial position of Adult Services.

2.

National Policy

2.1

The White Paper "Our Health, Our Care, Our Say" was published on 30 January 2006. It follows the earlier publication of a Green Paper on Social Care "Independence, Well-Being and Choice" in March 2005.

2.2

The green paper described seven clear outcomes for Social Care these being:

· Improved health

· Improved quality of life

· Making a positive contribution

· Exercise of choice and control

· Freedom from discrimination or harassment

· Economic well being; and

· Personal dignity

2.3

The White Paper sets out an ambitious programme of change, designed to bring commissioning and provision of community health and social care services together, to improve health and well-being by utilising community resources, and to offer better access and choice to users of community-based services.

2.4

The four main goals of the White Paper are:-

· better prevention services with earlier intervention;

· more choice and a louder voice;

· do more on tackling inequalities and improving access to community services;

· more support for people with long-term needs.

2.5

In order to achieve these aims, a number of enabling processes are described:-

· practice based commissioning;

· shifting resources into prevention;

· more care undertaken outside hospitals and in the home;

· better joining up of health and social care services at the local level;

· encouraging innovation in practice;

· allowing different providers to compete for services

3.

Demographic Changes

3.1

In terms of demographics Hampshire's population in common with that of England as a whole is ageing. The main features are illustrated in the following paragraphs.

3.2

Population overall is expected to grow by 104,000 (8.4%), this growth is accounted for entirely by growth in the population aged 65 or over (+106,000). Within this, the greatest level of growth is in the population aged 85 years or over which is expected to double by 2026 (an additional 25,000 people). The pensionable age population now is 26% of the working age population. By 2026 this proportion will have risen to 37%.

3.3

This implies mounting service pressures as a result of diminution in the caring-age population as well as the straight demographic increase: there will be fewer carers around to provide informal care for an increasingly dependent population of the very old. Families will be more likely than they are today to turn to the state for help. It is also likely to mean growing cost pressures as shrinkage in the working age population is likely to result in labour market shrinkage and higher wage costs.

4.

Financial Recovery

4.1

It is acknowledged that the present financial challenge is not unique to Hampshire. The latest figures from the Local Government Association indicate a national shortfall of some £1.7 billion

4.2

The final accounts for the Adult Services Departments 2005/06 show an overspend of £11.1m of which £8.3 million was within Older Persons services. Given the increase in client numbers in 2005/06 this includes a part year cost effect for care packages which will have a full year impact in 2006/07.

4.3

Work is being finalised on a two year financial plan which has the following work streams which focus on four recovery themes which are:

· Demand management, e.g. raised eligibility criteria and re-directing customers to other solutions at the point of referral is aimed at an overall reduction in numbers of clients and a reduction in average cost.

· Modernising the department by developing a new structure with associated reduction in head count to achieve optimum affordable staffing levels.

· Maximising income e.g. additional income from NRC implementation, timely collection of income from Section 28A and continuing care case resolution.

· Modernising in-house services through external contracts and development of alternative provision such as extra care sheltered housing and developing solutions outside traditional adult services (i.e. lowering unit costs). In addition, ensuring that there is optimal use of in-house services such as residential and nursing care by achieving high occupancy levels. As at April 2006 in-house occupancy was 95%, an increase of nearly 10% on the previous year.

5.

Promoting Well Being and Empowering Individuals

5.1

The Local Government Act 2000 re-emphasised and formalised the role of local government in this area, by placing upon them a statutory duty to "promote the social, economic and environmental well-being" of their communities. The definition of "well-being" is poorly defined, but most have taken this as a positive opportunity to move away from a concentration on the provision of services, to a more holistic, strategic approach to improving the lives of the people in their communities.

5.2

The White Paper Our Health, Our Care, Our Say, sets out the direction for Well Being to support independence by putting individuals and communities in control, with a focus on the prevention of ill-health and the promotion of well-being at all stages of their lives.

5.3

Within Hampshire County Council there is an established group who are leading on the Well Being of older people . It is essential that Adult Services harness these wider resources such as access to universal services to ensure that older people are not excluded from continuing to reach their optimum independence with the support of family, friends and the wider community. This will maximise the resources available to support Well Being and contribute to Adult Services financial recovery.

5.4

Alongside the focus on Well Being, national policy is describing a changing role for social care in terms of how individuals are supported to `navigate and broker' care solutions to support their individual needs. Indeed national research is underway on supporting self care. There are also changes planned in the next two years about how people access the `front door' to Adult Services, this being the development of the Hampshire County Council Contact centre which will signpost people as part of the navigation process. This will include directing people to universal services as well as `opening' the front door to Care Management and assessment services.

6.

Commissioning Purchasing and Partnerships

6.1

The commissioning plan for Older Persons services is now under review, this will involve working with service users and partner organisations to develop a robust plan that will set out the commissioning frame work from 2006-2010.

6.2

The commissioning plan will be based on a set of principles that will underpin all change and development work that supports Older people. These will need to be agreed with partners but are likely to include:

· support that is connected to community and mainstream life

· maintaining relationships

· opportunities to be as independent as possible whatever the environment

· networks of support NOT service solutions

· ageless solutions eg:support around the individual based on need not age

· value for money

6.3

Whilst the detail of this is yet to be developed there are key elements that will need to be integral to the plan these being:-

· A fundamental review of how Day Support Services are commissioned with a focus on how to utilise access to universal services and develop a range of choices for older people to maximise independence and well being

· The use of assistive technologies such as telecare to support people to continue living independently in their own homes

· Support for people at or as near to home as possible, this will include domiciliary care and Extra Care sheltered housing

· A capacity plan for the commissioning of long term care that enables Adult Service with our customers to manage and develop the market.

· Jointly commissioning care through care pathways that offer a range of interventions to manage demand in different ways, with benefits to customers, Adult Services Department and the NHS.

· Clear agreements with the NHS defining the responsibilities and accountabilities for the commissioning and delivery of Health and Social Care that detail explicitly redirection of existing resources.

7.

Local and Community Services

7.1

One of the enabling processes within the White paper is the development of Practice Based commissioning. The Department of Health set out the aspiration that `all practices will be involved in Practice Based Commissioning (PBC) by no later than the end of 2006.

7.2

The purpose of PBC is to maximise clinical innovation and quality by giving new freedoms to practices but within a support and accountability frame work which ensures proper and efficient use of public funds.

Adult Services will need to consider how it influences the NHS response at a locality level to the recovery themes which will require us to direct social care resources in line with financial recovery and eligibility criteria. This will require the department to ensure staff are equipped and supported to manage the interface with General Practice, Community Services and new providers which may emerge such as social enterprises.

8.

Locality Commissioning

8.1

As part of the restructuring of the Department it has been recognised that it will need to refocus working at a locality level. Within this there is the need to ensure the structures can also deliver the expected outcomes of Independence Well Being and Choice and support the delivery of sustainable financial recovery.

8.2

Adult Services will be working with PBC in developing this approach there is the potential to encourage both service users and the professionals supporting them to exercise choice and control, seeking creative solutions to the management of their Long Term Condition and for older people to remain independent and at home for as long as possible.

9

Modernising In House Services/ Contestability of Provision

9.1

Modernisation of Home Care Services

In December 2005 the Executive Member for Adult Social Care agreed for the Modernisation of the Home Care Service to commence. A key recommendation was that the in-house service should reposition itself within the domiciliary care market by providing a short term assessment and reablement service, that will link closely with care management, community health partners and existing Welcome Home Schemes.

9.2

Since December 2005, all home care teams have now been moved into larger locality teams that are aligned with care management. This has resulted in increased flexibility, shared workloads, economies of scale and improved working relationships with care management.

9.3

A single point of access to the service has been developed in most localities with an area co-ordinator function being provided by team leaders on a duty system. The introduction of home care team leaders into Reception and Assessment and hospital based teams has resulted in increased capacity and response times. Care managers have been released from entering data onto SWIFT where the in house service is involved and by undertaking the assessment and review of individual care packages the home care service is ensuring that purchased care is promoting independence and is cost effective.

10

Modernising and re-focusing In house Residential and Nursing Care

10.1

As part of the commissioning plan the department will be reviewing the balance of externally purchased services and in house provision. From current trends there is evidence that we will need to refocus the core of In House services. This will be the 500 nursing beds that have been developed as part of the ENHANCE project and the provision of specialist Residential Dementia Care services. These services will provide for service users with high care needs who are most difficult and expensive to place in the Independent sector. Therefore account will be taken of this when benchmarking our costs against independent sector provision.

10.2

In terms of the process there will be two aspects to the commissioning and planning to support this process. These being for current service users, and linked to the commissioning plan the future capacity requirements for residential and nursing care across Hampshire.

10.3

Both the changes in Home Care and In House Residential and Nursing provision need to be seen in the context of the role of Adult Services in the future. The commissioning of cost effective care and support services will require considerable flexibility and responsiveness from all providers. Therefore changes to in house capacity or focus will need to be reflected appropriately in the purchasing budget.

10.3

This work will be supported by a financial strategy for the development of additional Extra Care Housing capacity which will replace the more traditional residential care for older people who have retained independent living skills , but for whom continued living in their own home or current environment is no longer possible.

10.4

The delivery of this strand of the recovery plan will be undertaken in partnership with District and Borough Councils, Registered Social Landlords, Property Building and Regulatory Services the Supporting People team within Hampshire County Council.

11

Refocusing the Workforce /Care Management Practice

11.1

As part of service modernisation we will be restructuring the department to ensure there are the right staff with the right skills to support the delivery of best practice in social care.

Work force planning is already underway that will profile activity and analyse it in relation to the locality demography and local work force resourcing. This will help establish numbers and types of Social Care staff that will be needed across the county.

11.2

A further strand of work will be a review of Care Management practice and processes to ensure that Adult Services are delivering high quality practice, value for money and performance which leads to positive outcomes for older people.

12

Impact Assessment

12.1

In compiling this report and developing the strategy, regard has been given to the County Councils' duties in relation to the Race Relation Amendment Act 2000 and Hampshire County Council's own race equality scheme. No adverse impact has been identified.

13

Consultation with Local Members

13.1

The document sets out the strategic direction for Older persons services, Local Members will be consulted on detailed plans, including the Commissioning Plan for Older Persons Services.

14

Recommendations

That the:-

Executive member is asked to endorse the strategic direction for Older People services including the following specific actions :-

1) The development of a strategy to access universal services to support Well Being and independence of older people to ensure social care resources are targeted to those with greatest need thus supporting financial recovery

2) The development of a Commissioning plan for Older People that supports the delivery of sustainable financial recovery and joint working with key stakeholders and partner organisations

3) Development of comprehensive plans to refocus In House Services to deliver a modernised cost effective service that is integral to the overall commissioning plan.